Provider Demographics
NPI:1962034868
Name:GAMBLE, RUTH ANGELICA NAOMI (PA)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANGELICA NAOMI
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 MADONNA RD
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1031
Mailing Address - Country:US
Mailing Address - Phone:484-467-8211
Mailing Address - Fax:
Practice Address - Street 1:6821 REISTERSTOWN RD LOWR LVL
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1431
Practice Address - Country:US
Practice Address - Phone:410-358-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1170764363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1170764OtherNCCPA