Healthcare Provider Details

I. General information

NPI: 1538132873
Provider Name (Legal Business Name): PANKAJ LAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 W DIAMOND AVE STE 240
GAITHERSBURG MD
20878-1458
US

IV. Provider business mailing address

818 W DIAMOND AVE STE 240
GAITHERSBURG MD
20878-1458
US

V. Phone/Fax

Practice location:
  • Phone: 301-569-7135
  • Fax: 301-569-7134
Mailing address:
  • Phone: 301-569-7135
  • Fax: 301-569-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD39671
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: