Provider Demographics
NPI:1083665640
Name:GOR, RAHUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:
Last Name:GOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14201 LAUREL PARK DR
Mailing Address - Street 2:STE 102A
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5203
Mailing Address - Country:US
Mailing Address - Phone:301-604-9793
Mailing Address - Fax:888-272-4284
Practice Address - Street 1:14201 LAUREL PARK DR STE 102A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5203
Practice Address - Country:US
Practice Address - Phone:301-604-9793
Practice Address - Fax:888-272-4284
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01371213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94479Medicare UPIN
MD315P632GMedicare PIN