Healthcare Provider Details

I. General information

NPI: 1457667404
Provider Name (Legal Business Name): RAKESH GOYAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3773
US

IV. Provider business mailing address

175 HARRY S TRUMAN PKWY
ANNAPOLIS MD
21401-7573
US

V. Phone/Fax

Practice location:
  • Phone: 667-204-7333
  • Fax: 667-204-7359
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number052221
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35.125950
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0089230
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0146558
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: