Provider Demographics
NPI:1982100293
Name:GOWDA, ASHA (MD, MS)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:GOWDA
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3301
Mailing Address - Country:US
Mailing Address - Phone:978-371-7010
Mailing Address - Fax:978-371-0522
Practice Address - Street 1:92 MONTVALE AVE STE 3000
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3658
Practice Address - Country:US
Practice Address - Phone:781-438-6350
Practice Address - Fax:781-279-0430
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP05115207N00000X
MA1018030207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology