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NPI Code Detail

MEDICARE: KRISHNAJ GOURAB

MEDICARE: KRISHNAJ GOURAB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12083C0008XClinical Informatics PhysicianD76155MD
2208100000XPhysical Medicine & Rehabilitation PhysicianD76155MD

General Provider Information

NPI Number : 1538394242
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISHNAJ GOURAB
Provider Business Mailing Address
First Line : 2200 KERNAN DR
Second Line :
City : GWYNN OAK
State : MD
Zip : 21207-6665
Country : US
Telephone Number : 410-448-6895
Fax Number : 410-448-2895
Provider Business Practice Location Address
First Line : 2200 KERNAN DR
Second Line :
City : GWYNN OAK
State : MD
Zip : 21207-6665
Country : US
Telephone Number : 410-550-1715
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2009
Last Update Date : 03/22/2019

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