Provider Demographics
NPI:1457647018
Name:GANDOTRA, KAMAL (MD)
Entity Type:Individual
Prefix:MR
First Name:KAMAL
Middle Name:
Last Name:GANDOTRA
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 1:1253 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2307
Mailing Address - Country:US
Mailing Address - Phone:443-562-1597
Mailing Address - Fax:
Practice Address - Street 1:1253 4TH ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-2307
Practice Address - Country:US
Practice Address - Phone:443-562-1597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program