Provider Demographics
NPI:1386717148
Name:GAYOSO-ADAM, ELLA MAE (MD)
Entity type:Individual
Prefix:DR
First Name:ELLA
Middle Name:MAE
Last Name:GAYOSO-ADAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:301 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5803
Mailing Address - Country:US
Mailing Address - Phone:410-787-4594
Mailing Address - Fax:410-787-4846
Practice Address - Street 1:7556 TEAGUE RD
Practice Address - Street 2:SUITE 430
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1213
Practice Address - Country:US
Practice Address - Phone:410-553-8260
Practice Address - Fax:410-553-8261
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053717207VG0400X, 207VX0000X
DCMD21610207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409092600Medicaid
MDG85581Medicare UPIN