Provider Demographics
NPI:1669508107
Name:DAMIEN, GLORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:DAMIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 MAIDEN CHOICE LN
Mailing Address - Street 2:SUITE # 304
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5911
Mailing Address - Country:US
Mailing Address - Phone:410-719-0800
Mailing Address - Fax:410-719-0803
Practice Address - Street 1:724 MAIDEN CHOICE LN
Practice Address - Street 2:SUITE # 304
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-5911
Practice Address - Country:US
Practice Address - Phone:410-719-0800
Practice Address - Fax:410-719-0803
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD 24766207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine