Provider Demographics
NPI:1730348376
Name:PRINCE, GABRIELLE TOVA (MD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:TOVA
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1650 ORLEANS ST # 186
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0013
Mailing Address - Country:US
Mailing Address - Phone:646-734-5120
Mailing Address - Fax:410-955-8587
Practice Address - Street 1:401 NORTH BROADWAY
Practice Address - Street 2:ROOM 1363
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1146
Practice Address - Country:US
Practice Address - Phone:646-734-5120
Practice Address - Fax:410-955-8587
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY254586207R00000X
MDD73489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine