Healthcare Provider Details

I. General information

NPI: 1639155476
Provider Name (Legal Business Name): PAMELA GALLAGHER GUHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 PISCATAWAY RD SUITE 750
CLINTON MD
20735-2508
US

IV. Provider business mailing address

2026 HERMITAGE HILLS DR
GAMBRILLS MD
21054-2006
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-2810
  • Fax: 301-856-7290
Mailing address:
  • Phone: 301-261-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0016116
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD6387
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: