Provider Demographics
NPI:1649641713
Name:GAUDENZIA INC
Entity type:Organization
Organization Name:GAUDENZIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MBA
Authorized Official - Phone:410-367-5551
Mailing Address - Street 1:570 RITCHIE HWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2925
Mailing Address - Country:US
Mailing Address - Phone:410-975-0067
Mailing Address - Fax:
Practice Address - Street 1:106 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-4716
Practice Address - Country:US
Practice Address - Phone:610-239-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417123300Medicaid
MD1366656175OtherCOMMERCIAL