Provider Demographics
NPI:1659307049
Name:FORGASH, GLORIA J (CNM)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:J
Last Name:FORGASH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 KNOLL NORTH DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2300
Mailing Address - Country:US
Mailing Address - Phone:410-964-4600
Mailing Address - Fax:410-740-8654
Practice Address - Street 1:5450 KNOLL NORTH DR
Practice Address - Street 2:SUITE 320
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2300
Practice Address - Country:US
Practice Address - Phone:410-964-4600
Practice Address - Fax:410-740-8654
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR047883367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD006NJ045Medicare ID - Type Unspecified
S58775Medicare UPIN