Provider Demographics
NPI:1548445794
Name:GEMMA, PAUL A (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:GEMMA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3858 E LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2400
Mailing Address - Country:US
Mailing Address - Phone:410-327-3003
Mailing Address - Fax:410-327-3035
Practice Address - Street 1:3858 E LOMBARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2400
Practice Address - Country:US
Practice Address - Phone:410-327-3003
Practice Address - Fax:410-327-3035
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1563PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM077Medicare PIN
U17201Medicare UPIN