Basic Information
| Provider Information | |||||||||
| NPI: | 1952592818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAPUL-HIDALGO | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT. 453 PO BOX 1000 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285752625 | ||||||||
| FaxNumber: | 8283502174 | ||||||||
| Practice Location | |||||||||
| Address1: | 9210 CORPORATE BLVD STE 440 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208506520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2406317900 | ||||||||
| FaxNumber: | 2406317906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2007 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 0101261462 | VA | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207K00000X | D73813 | MD | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207K00000X | D0073813 | MD | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 1952592818 | 05 | VA | MEDICAID | 4691024-00 | 05 | MD | MEDICAID | 826726 | 01 | MD | MEDICARE PTAN | OTHER |