1366482283 NPI number — MS. PATRICIA G GENTRY MSW LCSW C

Table of content: DR. CHRISTIAN DANIEL WEAVER M.D. (NPI 1225449200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366482283 NPI number — MS. PATRICIA G GENTRY MSW LCSW C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GENTRY
Provider First Name:
PATRICIA
Provider Middle Name:
G
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366482283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2629 CHOPTANK MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-673-9074
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 SUNNYSIDE AVE
Provider Second Line Business Practice Location Address:
CAROLINE CO MENTAL HEALTH CLINIC
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-479-3800
Provider Business Practice Location Address Fax Number:
410-479-0052
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  07667 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: SW009544L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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