Provider Demographics
NPI:1932720232
Name:SRAHA, GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:SRAHA
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 1:22858 CABIN BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-3442
Mailing Address - Country:US
Mailing Address - Phone:516-639-5742
Mailing Address - Fax:
Practice Address - Street 1:707 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2650
Practice Address - Country:US
Practice Address - Phone:845-333-1758
Practice Address - Fax:184-533-3734
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program