Provider Demographics
NPI:1194861518
Name:GONDHALEKAR, SMITA SHRIDHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SMITA
Middle Name:SHRIDHAR
Last Name:GONDHALEKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SMITA
Other - Middle Name:SHRIDHATR
Other - Last Name:GONDHALEKAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:201 NORTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-237-4020
Practice Address - Fax:703-536-1395
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34865208000000X
DCMD16690208000000X
VA0101041279208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F50372Medicare UPIN
012526K92Medicare ID - Type Unspecified