Provider Demographics
NPI:1972531952
Name:KOWDLEY, GOPAL CHANDRU (MD, PHD, FACS)
Entity type:Individual
Prefix:
First Name:GOPAL
Middle Name:CHANDRU
Last Name:KOWDLEY
Suffix:
Gender:M
Credentials:MD, PHD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E CARROLL ST STE B202
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5454
Mailing Address - Country:US
Mailing Address - Phone:410-548-2600
Mailing Address - Fax:410-548-2607
Practice Address - Street 1:145 E CARROLL ST STE B202
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5454
Practice Address - Country:US
Practice Address - Phone:410-548-2600
Practice Address - Fax:410-548-2607
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD64173208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I16420Medicare UPIN