Provider Demographics
NPI:1780660001
Name:GOURDINE, MONIQUE CHERAE (DPM)
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:CHERAE
Last Name:GOURDINE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4853 CORDELL AVE APT 1016
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3024
Mailing Address - Country:US
Mailing Address - Phone:240-274-6589
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE DEPT OF PODIATRY BLD 19 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:240-274-6589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00261500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery