Provider Demographics
NPI:1417971466
Name:GANDHI, DEVANG H (MD)
Entity Type:Individual
Prefix:
First Name:DEVANG
Middle Name:H
Last Name:GANDHI
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:PO BOX 64515
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4515
Mailing Address - Country:US
Mailing Address - Phone:410-328-5881
Mailing Address - Fax:410-328-5882
Practice Address - Street 1:701 W PRATT ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:410-328-5881
Practice Address - Fax:410-328-5882
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00502122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD176810700Medicaid
MD821YMedicare PIN
MD176810700Medicaid
MDG23644Medicare UPIN