Healthcare Provider Details

I. General information

NPI: 1407894124
Provider Name (Legal Business Name): ATIYA H GOPALANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 PRINCE PHILIP DR STE 126
OLNEY MD
20832-1513
US

IV. Provider business mailing address

18111 PRINCE PHILIP DR STE 126
OLNEY MD
20832-1513
US

V. Phone/Fax

Practice location:
  • Phone: 301-570-4866
  • Fax: 301-570-0236
Mailing address:
  • Phone: 301-570-4866
  • Fax: 301-570-0236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD36981
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: