Healthcare Provider Details

I. General information

NPI: 1386870152
Provider Name (Legal Business Name): AMIR CYRUS GOHARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2009
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9063 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

IV. Provider business mailing address

8505 HAZELWOOD DR
BETHESDA MD
20814-1407
US

V. Phone/Fax

Practice location:
  • Phone: 301-921-6660
  • Fax:
Mailing address:
  • Phone: 301-530-5231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0075229
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: