Provider Demographics
NPI:1386759371
Name:DASTGIR, GHULAM (MD)
Entity type:Individual
Prefix:DR
First Name:GHULAM
Middle Name:
Last Name:DASTGIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1453 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1104
Mailing Address - Country:US
Mailing Address - Phone:410-988-2912
Mailing Address - Fax:410-777-5325
Practice Address - Street 1:1453 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1104
Practice Address - Country:US
Practice Address - Phone:410-988-2912
Practice Address - Fax:410-777-5325
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0073698207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0563170 00Medicaid
MD0563170 00Medicaid