Healthcare Provider Details

I. General information

NPI: 1972531952
Provider Name (Legal Business Name): GOPAL CHANDRU KOWDLEY M.D., PHD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E CARROLL ST STE B202
SALISBURY MD
21801-5454
US

IV. Provider business mailing address

145 E CARROLL ST STE B202
SALISBURY MD
21801-5454
US

V. Phone/Fax

Practice location:
  • Phone: 410-548-2600
  • Fax: 410-548-2607
Mailing address:
  • Phone: 410-548-2600
  • Fax: 410-548-2607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD64173
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: