Provider Demographics
NPI:1003854696
Name:LAND, GINA L (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:L
Last Name:LAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:795 EASTERN BYPASS
Mailing Address - Street 2:BUILDING 2, SUITE 5
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2406
Mailing Address - Country:US
Mailing Address - Phone:859-624-2229
Mailing Address - Fax:859-625-9458
Practice Address - Street 1:795 EASTERN BYPASS
Practice Address - Street 2:BUILDING 2, SUITE 5
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2406
Practice Address - Country:US
Practice Address - Phone:859-624-2229
Practice Address - Fax:859-625-9458
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2020-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY30567207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5533687OtherAETNA
KY000000215093OtherANTHEM BCBS
KY1482851OtherUNITED HEALTH CARE
KY6430567500Medicaid
KY160057188OtherRAILROAD MEDICARE
KY364489332OtherTAX ID #
KY0707901Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
KY6430567500Medicaid