1316969256 NPI number — MUKUL KHANDELWAL, PA

Table of content: DR. ROBERT CHARLES GARTSIDE PHARMD (NPI 1053407874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316969256 NPI number — MUKUL KHANDELWAL, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUKUL KHANDELWAL, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GASTRO ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316969256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8416
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKRIDGE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21075-7500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-590-8920
Provider Business Mailing Address Fax Number:
410-553-2345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8186 LARK BROWN RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKRIDGE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21075-6437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-590-8920
Provider Business Practice Location Address Fax Number:
410-553-2345
Provider Enumeration Date:
07/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KHANDELWAL
Authorized Official First Name:
MUKUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-590-8920

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  D0052387 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)