Healthcare Provider Details

I. General information

NPI: 1114029972
Provider Name (Legal Business Name): NIRUPMA ROHATGI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 SHADY GROVE COURT
GAITHERSBURG MD
20877
US

IV. Provider business mailing address

9015 SHADY GROVE COURT
GAITHERSBURG MD
20877
US

V. Phone/Fax

Practice location:
  • Phone: 301-963-0196
  • Fax: 301-963-3218
Mailing address:
  • Phone: 301-963-0196
  • Fax: 301-963-3218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD17454
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number7036
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: