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NPI Code Detail

MEDICARE: GINA AMBROSE D.O.

MEDICARE: GINA AMBROSE D.O.
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
12081P2900XPain Medicine (Physical Medicine & Rehabilitation) PhysicianH0078884MD
2207P00000XEmergency Medicine PhysicianH0078884MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790044220
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA AMBROSE D.O.
Provider Business Mailing Address
First Line : 157 BALTIMORE ST STE 100
Second Line :
City : CUMBERLAND
State : MD
Zip : 21502-2472
Country : US
Telephone Number : 301-722-0484
Fax Number : 833-903-0130
Provider Business Practice Location Address
First Line : 157 BALTIMORE ST STE 100
Second Line :
City : CUMBERLAND
State : MD
Zip : 21502-2472
Country : US
Telephone Number : 301-722-0484
Fax Number : 833-903-0130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2012
Last Update Date : 02/25/2026

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