Provider Demographics
NPI:1437519956
Name:GAUCHAN, BISHAL (PA-C)
Entity Type:Individual
Prefix:
First Name:BISHAL
Middle Name:
Last Name:GAUCHAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 MASSACHUSETTS AVE NW
Mailing Address - Street 2:APT 304
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4526
Mailing Address - Country:US
Mailing Address - Phone:301-204-1241
Mailing Address - Fax:
Practice Address - Street 1:7250 PARKWAY DR
Practice Address - Street 2:SUITE 500
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1388
Practice Address - Country:US
Practice Address - Phone:443-949-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC06803363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant