MEDICARE: AYESHA A GULISTAN

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
1	207R00000X	Internal Medicine Physician	D0075367	MD

General Provider Information

NPI Number	:	1609105386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYESHA A GULISTAN

Provider Business Mailing Address
First Line	:	515 FAIRMOUNT AVE STE 400
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-8518
Country	:	US
Telephone Number	:	410-196-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 WESTMINSTER PIKE STE 104
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-1027
Country	:	US
Telephone Number	:	410-526-3083
Fax Number	:	410-584-2240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2009
Last Update Date	:	04/11/2025

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Directions to “ AYESHA A GULISTAN ” Practice Location

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