=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518945542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PADMA GOWDA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9501 FARRELL RD
-----------------------------------------------------
City | FORT BELVOIR
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22060-5901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-805-0329
-----------------------------------------------------
Fax | 703-805-9979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9501 FARRELL RD
-----------------------------------------------------
City | FORT BELVOIR
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22060-5901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-805-0329
-----------------------------------------------------
Fax | 703-805-9979
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 0101046298
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------