Healthcare Provider Details

I. General information

NPI: 1285346551
Provider Name (Legal Business Name): PANDORA FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 BALTIMORE AVE STE 1
UNIVERSITY PARK MD
20782-2123
US

IV. Provider business mailing address

6300 BALTIMORE AVE STE 1
UNIVERSITY PARK MD
20782-2123
US

V. Phone/Fax

Practice location:
  • Phone: 301-200-0960
  • Fax: 250-999-6514
Mailing address:
  • Phone: 301-200-0960
  • Fax: 250-999-6514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RACHEL GOUGIAN
Title or Position: OWNER
Credential: DO
Phone: 978-302-8798