Provider Demographics
NPI:1568532208
Name:GOWDA, BHARATHI (MD)
Entity Type:Individual
Prefix:
First Name:BHARATHI
Middle Name:
Last Name:GOWDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BHARATHI
Other - Middle Name:
Other - Last Name:PRABHAKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1410 CRAIN HWY N.W.
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-760-5885
Mailing Address - Fax:410-760-6683
Practice Address - Street 1:1410 CRAIN HWY N.W.
Practice Address - Street 2:SUITE NO 4A
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-760-5885
Practice Address - Fax:410-760-6683
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023250207V00000X
MDD23250207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD255241800Medicaid
B70064Medicare UPIN
MD7069Medicare ID - Type Unspecified
MDB70064Medicare UPIN
MD141409Medicare PIN