Provider Demographics
NPI:1598884207
Name:GAINES, TANGELA M (PA-C)
Entity Type:Individual
Prefix:
First Name:TANGELA
Middle Name:M
Last Name:GAINES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6569
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2001 MEDICAL PARKWAY
Practice Address - Street 2:ACUTE CARE PAVILION
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-6482
Practice Address - Fax:443-481-6515
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03729363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
607156014OtherFEDERAL BLACK LUNG
607156012OtherUS DEPT. OF LABOR
607156012OtherDEPT OF LABOR (FEDERAL)
607156012OtherDEPT OF LABOR (FEDERAL)
P00917231Medicare PIN