Provider Demographics
NPI:1619667128
Name:GENTNER, BLAKEMORE ZELDA (MD)
Entity Type:Individual
Prefix:
First Name:BLAKEMORE
Middle Name:ZELDA
Last Name:GENTNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAURA
Other - Middle Name:BLAKEMORE
Other - Last Name:GENTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6017 FOXHALL FARM RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5305
Mailing Address - Country:US
Mailing Address - Phone:443-632-8203
Mailing Address - Fax:
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program