Provider Demographics
NPI:1407894124
Name:GOPALANI, ATIYA H (MD)
Entity Type:Individual
Prefix:
First Name:ATIYA
Middle Name:H
Last Name:GOPALANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18111 PRINCE PHILIP DR
Mailing Address - Street 2:STE 126
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1513
Mailing Address - Country:US
Mailing Address - Phone:301-570-4866
Mailing Address - Fax:301-570-0236
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:STE 126
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-570-4866
Practice Address - Fax:301-570-0236
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD36981207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3782401608OtherBC MD
DC40850001OtherBC DC/METRO
MD296531301Medicaid
MD833373OtherUHC GROUP
MD3782401608OtherBC MD
MD420527Medicare PIN