Provider Demographics
NPI:1669819389
Name:TELHAN, GANDHARV (DO)
Entity Type:Individual
Prefix:DR
First Name:GANDHARV
Middle Name:
Last Name:TELHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:GANDHRAV
Other - Middle Name:
Other - Last Name:TELHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 748613
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10322 BRISTOW CENTER DR
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2201
Practice Address - Country:US
Practice Address - Phone:571-284-4245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine