Provider Demographics
NPI:1912361536
Name:GOYAL, KAVITA (MD)
Entity Type:Individual
Prefix:
First Name:KAVITA
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:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20830-0769
Mailing Address - Country:US
Mailing Address - Phone:301-598-4500
Mailing Address - Fax:301-598-3797
Practice Address - Street 1:3801 INTERNATIONAL DR STE 211
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1550
Practice Address - Country:US
Practice Address - Phone:301-598-4500
Practice Address - Fax:301-598-3797
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-09
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0088309207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program