Provider Demographics
NPI:1255470969
Name:LINSANGAN, MA GLADYS MARCELO (MD)
Entity Type:Individual
Prefix:DR
First Name:MA GLADYS
Middle Name:MARCELO
Last Name:LINSANGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#816 N MARINE DR
Mailing Address - Street 2:STE 108 SUITE 101 428 CHALAN SAN ANTONIO
Mailing Address - City:TUMON
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-646-2181
Mailing Address - Fax:671-646-2182
Practice Address - Street 1:#816 N MARINE DR
Practice Address - Street 2:STE 108 SUITE 101 428 CHALAN SAN ANTONIO
Practice Address - City:TUMON
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-646-2181
Practice Address - Fax:671-646-2182
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001405208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
56689OtherPIN
G23443Medicare UPIN