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General NPI Number Information
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NPI Number | 1609105386
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Entity Type | Individual
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Provider Name | AYESHA A GULISTAN
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Gender | Female
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 120 WESTMINSTER PIKE STE 104
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City | REISTERSTOWN
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State | MD
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Zip | 21136-1027
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Country | US
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Telephone | 410-526-3083
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Fax | 410-584-2240
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Provider Business Mailing Address
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Address Line | 515 FAIRMOUNT AVE STE 400
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City | TOWSON
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State | MD
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Zip | 21286-8518
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Country | US
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Telephone | 410-196-5300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0075367
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License Number State | MD
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