Healthcare Provider Details

I. General information

NPI: 1689611691
Provider Name (Legal Business Name): PARAG DINESH GANDHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9110 PHILADELPHIA RD STE 108
ROSEDALE MD
21237-4323
US

IV. Provider business mailing address

9110 PHILADELPHIA RD STE 108
ROSEDALE MD
21237-4323
US

V. Phone/Fax

Practice location:
  • Phone: 410-517-7957
  • Fax: 833-944-1871
Mailing address:
  • Phone: 410-517-7957
  • Fax: 833-944-1871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0084895
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberD0084895
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: