MEDICARE: DR. MA GLADYS MARCELO LINSANGAN MD

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	208000000X	Pediatrics Physician	M001405	GU

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56689	OTHER		PIN

General Provider Information

NPI Number	:	1255470969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MA GLADYS MARCELO LINSANGAN MD

Provider Business Mailing Address
First Line	:	#816 N MARINE DR
Second Line	:	STE 108 SUITE 101 428 CHALAN SAN ANTONIO
City	:	TUMON
State	:	GU
Zip	:	96913
Country	:	US
Telephone Number	:	671-646-2181
Fax Number	:	671-646-2182

Provider Business Practice Location Address
First Line	:	#816 N MARINE DR
Second Line	:	STE 108 SUITE 101 428 CHALAN SAN ANTONIO
City	:	TUMON
State	:	GU
Zip	:	96913
Country	:	US
Telephone Number	:	671-646-2181
Fax Number	:	671-646-2182

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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