Provider Demographics
NPI:1164141909
Name:COBB, GUDRUN
Entity Type:Individual
Prefix:
First Name:GUDRUN
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GUDRUN
Other - Middle Name:
Other - Last Name:LOERCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:537 BUDDS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:MD
Mailing Address - Zip Code:21912-1255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:537 BUDDS LANDING RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:MD
Practice Address - Zip Code:21912-1255
Practice Address - Country:US
Practice Address - Phone:410-275-8597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00701652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology