Provider Demographics
NPI:1912930108
Name:GENDELSMAN, INNA (MD)
Entity Type:Individual
Prefix:DR
First Name:INNA
Middle Name:
Last Name:GENDELSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INNA
Other - Middle Name:
Other - Last Name:KARPUSHOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 62026
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1205 YORK RD
Practice Address - Street 2:SUITE # 38
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6210
Practice Address - Country:US
Practice Address - Phone:410-825-4979
Practice Address - Fax:410-296-3630
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS190 / 0010OtherBLUE CHOICE
MD2457712OtherAETNA
MDKF68 / 548613-03OtherBC/BS OF MD
MDKL28 / 92WWMedicare ID - Type Unspecified
MDG77123Medicare UPIN