Healthcare Provider Details

I. General information

NPI: 1548572290
Provider Name (Legal Business Name): GOHAR CHOUDHARY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43130 AMBERWOOD PLZ SUITE 140
SOUTH RIDING VA
20152-4105
US

IV. Provider business mailing address

43130 AMBERWOOD PLZ SUITE 140
SOUTH RIDING VA
20152-4105
US

V. Phone/Fax

Practice location:
  • Phone: 703-348-0030
  • Fax: 703-542-7770
Mailing address:
  • Phone: 703-348-0030
  • Fax: 703-542-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101252060
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: