Provider Demographics
NPI:1821257478
Name:GOWDA, PALLAVI (DO)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:GOWDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PALLAVI
Other - Middle Name:
Other - Last Name:BELUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:15005 SHADY GROVE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6358
Mailing Address - Country:US
Mailing Address - Phone:301-309-0940
Mailing Address - Fax:660-951-7834
Practice Address - Street 1:15005 SHADY GROVE RD STE 220
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6358
Practice Address - Country:US
Practice Address - Phone:301-309-0940
Practice Address - Fax:660-951-7834
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-07
Last Update Date:2022-08-10
Deactivation Date:2019-01-23
Deactivation Code:
Reactivation Date:2019-02-06
Provider Licenses
StateLicense IDTaxonomies
MDH77149207R00000X
MDH0077149207R00000X
DCDO034456207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine