Provider Demographics
NPI:1720182249
Name:GOYAL, SUSHMA (MD)
Entity Type:Individual
Prefix:
First Name:SUSHMA
Middle Name:
Last Name:GOYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 SOUTHERN AVE SE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4689
Mailing Address - Country:US
Mailing Address - Phone:202-562-4100
Mailing Address - Fax:202-562-4101
Practice Address - Street 1:1328 SOUTHERN AVE SE
Practice Address - Street 2:SUITE 316
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4689
Practice Address - Country:US
Practice Address - Phone:202-562-4100
Practice Address - Fax:202-562-4101
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD7081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD383341100Medicaid
DC025205800Medicaid