Provider Demographics
NPI:1578693958
Name:AMOROSO, GINA M (DO)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:AMOROSO
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:NEMOURS PEDIATRICS JESSUP ST.
Practice Address - Street 2:1602 JESSUP STREET
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-4210
Practice Address - Country:US
Practice Address - Phone:302-576-5050
Practice Address - Fax:302-576-5065
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC20008401208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102034655Medicaid
MD4131371Medicaid
NJ0138487Medicaid