Individual provider Active NPI

Gloria Damien, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Baltimore, MD
National Provider Identifier
1669508107
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
D 24766 Issued in MD
Practice address
724 Maiden Choice LN
Suite # 304
Baltimore, MD 21228-5911
Phone
(410) 719-0800
Fax
(410) 719-0803
NPI assigned
Feb 27, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X D 24766 MD Primary

Addresses

Primary practice location

724 Maiden Choice LN
Suite # 304
Baltimore, MD 21228-5911

Mailing address

724 Maiden Choice LN
Suite # 304
Baltimore, MD 21228-5911
Phone (410) 719-0800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190820003570 MO Practitioner - Internal Medicine 1850569070 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D 24766MDMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Magers Family Health and Wellness Center CurrentSince Aug 9, 2019 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

901 S National Ave
Springfield, MO 65897
Phone (417) 836-4000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669508107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 MAIDEN CHOICE LN",
            "address_2": "SUITE # 304",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212285911",
            "telephone_number": "410-719-0800",
            "fax_number": "410-719-0803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 MAIDEN CHOICE LN",
            "address_2": "SUITE # 304",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212285911",
            "telephone_number": "410-719-0800",
            "fax_number": "410-719-0803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMIEN",
        "first_name": "GLORIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MD",
            "license": "D 24766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.