Provider Demographics
NPI:1497709463
Name:GOUEL, ELIAS GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:GEORGE
Last Name:GOUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7401 OSLER DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7673
Mailing Address - Country:US
Mailing Address - Phone:410-583-6800
Mailing Address - Fax:410-583-5259
Practice Address - Street 1:7401 OSLER DR
Practice Address - Street 2:SUITE 209
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7673
Practice Address - Country:US
Practice Address - Phone:410-583-6800
Practice Address - Fax:410-583-5259
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD20970208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD973511900Medicaid
MDB70721Medicare UPIN