Provider Demographics
NPI:1982660114
Name:GOLLE, GLORIA DUKA (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:DUKA
Last Name:GOLLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8186 LARK BROWN RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6433
Mailing Address - Country:US
Mailing Address - Phone:410-730-9898
Mailing Address - Fax:410-730-9990
Practice Address - Street 1:8186 LARK BROWN ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:ELLERIDEE
Practice Address - State:MD
Practice Address - Zip Code:21075-6435
Practice Address - Country:US
Practice Address - Phone:410-730-9898
Practice Address - Fax:410-730-9990
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2011-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD43899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD439RMedicare ID - Type Unspecified
F82471Medicare UPIN