Provider Demographics
NPI:1285346551
Name:PANDORA FAMILY MEDICINE
Entity type:Organization
Organization Name:PANDORA FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-302-8798
Mailing Address - Street 1:6300 BALTIMORE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2123
Mailing Address - Country:US
Mailing Address - Phone:301-200-0960
Mailing Address - Fax:250-999-6514
Practice Address - Street 1:6300 BALTIMORE AVE STE 1
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:MD
Practice Address - Zip Code:20782-2123
Practice Address - Country:US
Practice Address - Phone:301-200-0960
Practice Address - Fax:250-999-6514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty