Provider Demographics
NPI:1578783510
Name:ELLA GAYOSO-ADAM MD PA
Entity Type:Organization
Organization Name:ELLA GAYOSO-ADAM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:GAYOSO-ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-647-8866
Mailing Address - Street 1:273 PENINSULA FARM RD
Mailing Address - Street 2:BUILDING 2 SUITE F
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1012
Mailing Address - Country:US
Mailing Address - Phone:410-647-8866
Mailing Address - Fax:410-647-7707
Practice Address - Street 1:273 PENINSULA FARM RD
Practice Address - Street 2:BUILDING 2 SUITE F
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1012
Practice Address - Country:US
Practice Address - Phone:410-647-8866
Practice Address - Fax:410-647-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053717207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG85581Medicare UPIN