Healthcare Provider Details

I. General information

NPI: 1437519956
Provider Name (Legal Business Name): BISHAL GAUCHAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 PARKWAY DR SUITE 500
HANOVER MD
21076-1388
US

IV. Provider business mailing address

1234 MASSACHUSETTS AVE NW APT 304
WASHINGTON DC
20005-4526
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-0814
  • Fax:
Mailing address:
  • Phone: 301-204-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC06803
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: