Provider Demographics
NPI:1568608701
Name:GEGOR, CAROLYN L (CNM, MS)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:L
Last Name:GEGOR
Suffix:
Gender:F
Credentials:CNM, MS
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Mailing Address - Street 1:10951 HARMEL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3784
Mailing Address - Country:US
Mailing Address - Phone:410-707-7607
Mailing Address - Fax:
Practice Address - Street 1:301 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5803
Practice Address - Country:US
Practice Address - Phone:410-553-8260
Practice Address - Fax:410-553-8261
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR062257367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife