MEDICARE: DIVYANGKUMAR K GANDHI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207RG0100X	Gastroenterology Physician	0101262426	VA

General Provider Information

NPI Number	:	1386993343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIVYANGKUMAR K GANDHI MD

Provider Business Mailing Address
First Line	:	165 WADSWORTH DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-4500
Country	:	US
Telephone Number	:	804-330-4901
Fax Number	:	804-330-9141

Provider Business Practice Location Address
First Line	:	8415 N RUN MEDICAL DR
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2309
Country	:	US
Telephone Number	:	804-559-6194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2012
Last Update Date	:	07/17/2024

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