Individual
GWYN HARRISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1050 W INDUSTRIAL BLVD, SUITE 18, CUMBERLAND, MD 21502-4331
(301) 777-7525
(301) 777-0184
Mailing address
1050 W INDUSTRIAL BLVD, SUITE 18, CUMBERLAND, MD 21502-4331
(301) 777-7525
(301) 777-0184
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D33776
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0091154000
—
WV
01
—
160004761
TRAVELERS MEDICARE PTAN
MD
01
—
219775
MAMSI
MD
05
—
408181100
—
MD
01
—
4102
BLUE SHIELD OF MARYLAND
MD
01
—
4102
MEDICARE PTAN
PA
01
—
4667874
AETNA
MD
Enumeration date
08/24/2005
Last updated
06/09/2010
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