Provider Demographics
NPI:1801068002
Name:GAGEN-HURSEY, THERESA J (RNPNP)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:J
Last Name:GAGEN-HURSEY
Suffix:
Gender:F
Credentials:RNPNP
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:HURSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10807 FALLS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4591
Mailing Address - Country:US
Mailing Address - Phone:410-321-9393
Mailing Address - Fax:410-825-4945
Practice Address - Street 1:10807 FALLS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4591
Practice Address - Country:US
Practice Address - Phone:410-321-9393
Practice Address - Fax:410-825-4945
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN51181208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLL96MAOtherBLUE SHIELD OF MD