Healthcare Provider Details

I. General information

NPI: 1396093068
Provider Name (Legal Business Name): INDER S GUJRAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8795 ENDLESS OCEAN WAY
COLUMBIA MD
21045-5938
US

IV. Provider business mailing address

8795 ENDLESS OCEAN WAY
COLUMBIA MD
21045-5938
US

V. Phone/Fax

Practice location:
  • Phone: 410-290-1112
  • Fax:
Mailing address:
  • Phone: 410-290-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35.045890
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: