Provider Demographics
NPI:1962628735
Name:GOGTAY, NITIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NITIN
Middle Name:
Last Name:GOGTAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10207 SILVER BELL TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7407
Mailing Address - Country:US
Mailing Address - Phone:301-613-2910
Mailing Address - Fax:240-465-0306
Practice Address - Street 1:10207 SILVER BELL TER
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7407
Practice Address - Country:US
Practice Address - Phone:301-613-2910
Practice Address - Fax:240-465-0306
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00557602084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine