Provider Demographics
NPI:1235224452
Name:YOUNGBLOOD, GWENDOLYN VIRGINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:VIRGINIA
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7525 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3509
Mailing Address - Country:US
Mailing Address - Phone:301-441-4555
Mailing Address - Fax:301-441-3420
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 311
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-441-4555
Practice Address - Fax:301-441-3420
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0047050208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F95507Medicare UPIN