Provider Demographics
NPI:1952057408
Name:GENTILE, MARY ANGELINA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELINA
Last Name:GENTILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 REMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-3025
Mailing Address - Country:US
Mailing Address - Phone:410-235-1776
Mailing Address - Fax:
Practice Address - Street 1:2544 QUARRY LAKE DR # A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3759
Practice Address - Country:US
Practice Address - Phone:410-337-7940
Practice Address - Fax:410-558-6835
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMO4617225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist