Healthcare Provider Details

I. General information

NPI: 1518117530
Provider Name (Legal Business Name): SHITAL GANDHI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ST. PAUL PLACE BUSINESS HEALTH SERVICES
BALTIMORE MD
21202
US

IV. Provider business mailing address

301 ST. PAUL PLACE MEDICAL STAFF OFFICE
BALTIMORE MD
21202
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9233
  • Fax:
Mailing address:
  • Phone: 410-659-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0003803
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: