Basic Information
| Provider Information | |||||||||
| NPI: | 1437195062 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEMMELL | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5525 RESEARCH PARK DR FL 4 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212284873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015728340 | ||||||||
| FaxNumber: | 3015728403 | ||||||||
| Practice Location | |||||||||
| Address1: | 3110 GRACEFIELD RD | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015728340 | ||||||||
| FaxNumber: | 3015728403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | R158667 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 62119701 | 01 | MD | BCBS OF MD | OTHER | 0036 | 01 | CAREFIRST | OTHER | 52-2096682 | 01 | TRICARE NORTH | OTHER | 8301559 | 01 | EVERCARE | OTHER | 403206300 | 05 | MD | MEDICAID | 262573538002 | 01 | TRICARE - EMPLOYEE HEALTH | OTHER |