Provider Demographics
NPI:1942849468
Name:GARCIA, ADELAIDE ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:ADELAIDE
Middle Name:ELIZABETH
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ADELAIDE
Other - Middle Name:ELIZABETH
Other - Last Name:BERTRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2772 LIGHTHOUSE PT E UNIT 212
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5051
Mailing Address - Country:US
Mailing Address - Phone:570-574-0681
Mailing Address - Fax:
Practice Address - Street 1:1800 ORLEANS ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0010
Practice Address - Country:US
Practice Address - Phone:410-955-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-01
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR209373208000000X, 390200000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR209373OtherLICENSE