Provider Demographics
NPI:1073243960
Name:GATEWAY HEALTHCARE CONNECTIONS
Entity Type:Organization
Organization Name:GATEWAY HEALTHCARE CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NDUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-356-1494
Mailing Address - Street 1:2813 PULASKI HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-1343
Mailing Address - Country:US
Mailing Address - Phone:443-356-1494
Mailing Address - Fax:
Practice Address - Street 1:2813 PULASKI HWY STE 104
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1343
Practice Address - Country:US
Practice Address - Phone:443-356-1494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)