Provider Demographics
NPI:1043275449
Name:GONCHIGAR, MRUTHYUNJAYA (MD)
Entity Type:Individual
Prefix:
First Name:MRUTHYUNJAYA
Middle Name:
Last Name:GONCHIGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4397
Mailing Address - Country:US
Mailing Address - Phone:301-668-9988
Mailing Address - Fax:301-668-9977
Practice Address - Street 1:196 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 215
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4397
Practice Address - Country:US
Practice Address - Phone:301-668-9988
Practice Address - Fax:301-668-9977
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050726208VP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00875961OtherMEDICARE RAILROAD
MD697L395DOtherPAIN MANAGEMENT
MD702L410DMedicare PIN
MDP00875961OtherMEDICARE RAILROAD
MD697L395DOtherPAIN MANAGEMENT