Healthcare Provider Details

I. General information

NPI: 1295046530
Provider Name (Legal Business Name): EVGENIA GOURGARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NIH DEVELOPMENTAL ENDOCRINOLOGY & GENETICS BLDG. 10, ROOM 9D-42 ,10 CENTER DRIVE MSC 1830
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

NIH DEVELOPMENTAL ENDOCRINOLOGY & GENETICS BLDG. 10, ROOM 9D-42 , 10 CENTER DRIVE MSC 1830
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-451-1466
  • Fax:
Mailing address:
  • Phone: 301-451-1466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN 10977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: