Provider Demographics
NPI:1861682957
Name:KULARATNA, GOWRI (MD)
Entity Type:Individual
Prefix:DR
First Name:GOWRI
Middle Name:
Last Name:KULARATNA
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 1:12070 OLD LINE CTR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12070 OLD LINE CTR
Practice Address - Street 2:SUITE 200
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2513
Practice Address - Country:US
Practice Address - Phone:301-645-8035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine