MEDICARE: JOSEPHINE GANG CRNP-PMH

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R223583	MD

General Provider Information

NPI Number	:	1831804350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE GANG CRNP-PMH

Provider Business Mailing Address
First Line	:	4061 POWDER MILL RD STE 400-1
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-3149
Country	:	US
Telephone Number	:	301-502-6460
Fax Number	:	608-305-8787

Provider Business Practice Location Address
First Line	:	4061 POWDER MILL RD STE 400-1
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-3149
Country	:	US
Telephone Number	:	301-502-6460
Fax Number	:	608-305-8787

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

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	01/19/2026

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