Provider Demographics
NPI:1699963645
Name:GERSHENZON, BELLA N
Entity type:Individual
Prefix:MRS
First Name:BELLA
Middle Name:N
Last Name:GERSHENZON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 FOX LAIR DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6222
Mailing Address - Country:US
Mailing Address - Phone:410-526-6338
Mailing Address - Fax:410-526-6338
Practice Address - Street 1:312 FOX LAIR DR
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-6222
Practice Address - Country:US
Practice Address - Phone:410-526-6338
Practice Address - Fax:410-526-6338
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor