Provider Demographics
NPI:1104063247
Name:GATDULA & GATULA M.D., P.A.
Entity type:Organization
Organization Name:GATDULA & GATULA M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTETA
Authorized Official - Middle Name:LORICA
Authorized Official - Last Name:GATDULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-760-2311
Mailing Address - Street 1:202 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5802
Mailing Address - Country:US
Mailing Address - Phone:410-760-2311
Mailing Address - Fax:410-760-8219
Practice Address - Street 1:202 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5802
Practice Address - Country:US
Practice Address - Phone:410-760-2311
Practice Address - Fax:410-760-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty