Provider Demographics
NPI:1649688698
Name:GULATI, RISHABH (MD)
Entity type:Individual
Prefix:
First Name:RISHABH
Middle Name:
Last Name:GULATI
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 1:3261 NW MOUNT VINTAGE WAY STE 221
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-6039
Mailing Address - Country:US
Mailing Address - Phone:360-479-1952
Mailing Address - Fax:360-479-0318
Practice Address - Street 1:3261 NW MOUNT VINTAGE WAY STE 221
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-6039
Practice Address - Country:US
Practice Address - Phone:360-479-1952
Practice Address - Fax:360-479-0318
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61000957207RG0100X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2162030Medicaid