Provider Demographics
NPI:1124487111
Name:GLADSTONE PSYCHIATRY AND WELLNESS
Entity type:Organization
Organization Name:GLADSTONE PSYCHIATRY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-630-3339
Mailing Address - Street 1:600 WYNDHURST AVE
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2489
Mailing Address - Country:US
Mailing Address - Phone:410-630-3339
Mailing Address - Fax:443-478-4698
Practice Address - Street 1:600 WYNDHURST AVE
Practice Address - Street 2:SUITE 200A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2489
Practice Address - Country:US
Practice Address - Phone:410-630-3339
Practice Address - Fax:443-478-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00454772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty