Individual
CHARLISA DEANDRA GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MBBS
Contact information
Practice address
255 HOSPITAL DR FL 3, GLEN BURNIE, MD 21061-6356
(410) 553-8240
(410) 553-8239
Mailing address
255 HOSPITAL DR FL 3, GLEN BURNIE, MD 21061-6356
(410) 553-8240
(410) 553-8239
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
284648
NY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
D0090376
MD
Other
Enumeration date
03/29/2012
Last updated
12/16/2025
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