Healthcare Provider Details

I. General information

NPI: 1518192145
Provider Name (Legal Business Name): BAIJU S GANDHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 L ST NW
WASHINGTON DC
20037-1527
US

IV. Provider business mailing address

701 W PRATT ST PSYCHIATRY, 4TH FLOOR
BALTIMORE MD
21201-1023
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2888
  • Fax:
Mailing address:
  • Phone: 410-328-5076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberMD041620
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: