Healthcare Provider Details

I. General information

NPI: 1083281141
Provider Name (Legal Business Name): CHRIS GAUTHIER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13121 BROOKLANE DR
HAGERSTOWN MD
21742-1514
US

IV. Provider business mailing address

11116 MEDICAL CAMPUS RD
HAGERSTOWN MD
21742-6710
US

V. Phone/Fax

Practice location:
  • Phone: 301-733-0330
  • Fax:
Mailing address:
  • Phone: 301-766-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOT020810
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberH0104466
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: