MEDICARE: WANDA HUSSEIN GASS P.A.

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	363A00000X	Physician Assistant	25MP00032500	NJ

General Provider Information

NPI Number	:	1457425183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA HUSSEIN GASS P.A.

Provider Business Mailing Address
First Line	:	2305 S 7TH ST
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08104-2546
Country	:	US
Telephone Number	:	856-969-9111
Fax Number	:

Provider Business Practice Location Address
First Line	:	8094 SANDPIPER CIR
Second Line	:	SUITE O
City	:	BALTIMORE
State	:	MD
Zip	:	21236-4907
Country	:	US
Telephone Number	:	410-933-3017
Fax Number	:

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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