MEDICARE: ANGELA MARIA GARDINER II BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	T66195596	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225751738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIA GARDINER II BA

Provider Business Mailing Address
First Line	:	9500 ANNAPOLIS RD
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-2060
Country	:	US
Telephone Number	:	301-850-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 ANNAPOLIS RD STE C2
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-2073
Country	:	US
Telephone Number	:	703-801-6811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	09/22/2022

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