MEDICARE: GERICALLS LLC

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	363LG0600X	Gerontology Nurse Practitioner	R086637	MD

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	:	1649301292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERICALLS LLC

Provider Business Mailing Address
First Line	:	3250 STARTING GATE CT
Second Line	:
City	:	WOODBINE
State	:	MD
Zip	:	21797-7937
Country	:	US
Telephone Number	:	443-271-0688
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 STARTING GATE CT
Second Line	:
City	:	WOODBINE
State	:	MD
Zip	:	21797-7937
Country	:	US
Telephone Number	:	443-271-0688
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELLEN R FARRELL
Credential	:	CRNP
Telephone Number	:	443-271-0688

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	06/17/2008

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Directions to “GERICALLS LLC ” Practice Location

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