Provider Demographics
NPI:1538437223
Name:GARDELLA, CHRISTINE T (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:T
Last Name:GARDELLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:115 ROESLER RD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-6519
Mailing Address - Country:US
Mailing Address - Phone:410-766-8009
Mailing Address - Fax:410-766-8022
Practice Address - Street 1:12070 OLD LINE CTR
Practice Address - Street 2:SUITE 302
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2513
Practice Address - Country:US
Practice Address - Phone:301-645-6667
Practice Address - Fax:301-870-9722
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0004642363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical