Provider Demographics
NPI:1174635536
Name:GIBBS, ANGELA L (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:L
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11200 RACETRACK RD
Mailing Address - Street 2:STE A104
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3809
Mailing Address - Country:US
Mailing Address - Phone:410-973-1030
Mailing Address - Fax:410-973-1029
Practice Address - Street 1:11200 RACETRACK RD
Practice Address - Street 2:STE A104
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3809
Practice Address - Country:US
Practice Address - Phone:410-973-1030
Practice Address - Fax:410-973-1029
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA038773207Q00000X
MDD0066169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI19288Medicare UPIN
MDI19288Medicare UPIN