Provider Demographics
NPI:1073878880
Name:MANALAI, GUL GHUTAI (MD)
Entity Type:Individual
Prefix:
First Name:GUL
Middle Name:GHUTAI
Last Name:MANALAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:106 PINE BLUFF RD
Mailing Address - Street 2:#11
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7161
Mailing Address - Country:US
Mailing Address - Phone:410-742-2255
Mailing Address - Fax:470-742-2589
Practice Address - Street 1:106 PINE BLUFF RD
Practice Address - Street 2:#11
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7161
Practice Address - Country:US
Practice Address - Phone:410-742-2255
Practice Address - Fax:470-742-2589
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125062343208000000X
MDD0079441208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0943151 00Medicaid