Healthcare Provider Details

I. General information

NPI: 1184801813
Provider Name (Legal Business Name): NEERAJ GANDOTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE JHBMC
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

1253 4TH ST SW
WASHINGTON DC
20024-2307
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0100
  • Fax:
Mailing address:
  • Phone: 443-838-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberD0067343
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: