Provider Demographics
NPI:1306815386
Name:GAN-CARDEN, REGINA M (MD, FACP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:GAN-CARDEN
Suffix:
Gender:F
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 E 33RD ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3017
Mailing Address - Country:US
Mailing Address - Phone:410-645-0868
Mailing Address - Fax:240-254-0842
Practice Address - Street 1:1040 E 33RD ST
Practice Address - Street 2:SUITE #2
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3017
Practice Address - Country:US
Practice Address - Phone:410-645-0868
Practice Address - Fax:240-254-0842
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061731207R00000X
MDD61731207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I22534Medicare UPIN