Provider Demographics
NPI:1346605318
Name:GAMBLE, RICHARD DAVID JR (RN, LMBT, LMT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:GAMBLE
Suffix:JR
Gender:M
Credentials:RN, LMBT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4226
Mailing Address - Country:US
Mailing Address - Phone:910-273-5351
Mailing Address - Fax:
Practice Address - Street 1:8955 GUILFORD RD
Practice Address - Street 2:#240
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2651
Practice Address - Country:US
Practice Address - Phone:443-393-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC198410163W00000X
MDM05495225700000X
NC01053225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse