Provider Demographics
NPI:1871258186
Name:LEGALUPPI, GINA NICOLE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:GINA
Middle Name:NICOLE
Last Name:LEGALUPPI
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8322 BELLONA AVE RM 100
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2063
Mailing Address - Country:US
Mailing Address - Phone:410-337-7900
Mailing Address - Fax:410-821-1334
Practice Address - Street 1:8322 BELLONA AVE RM 100
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2063
Practice Address - Country:US
Practice Address - Phone:410-337-7900
Practice Address - Fax:410-821-1334
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0009739363AS0400X
VA0110008652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical