Provider Demographics
NPI:1992328264
Name:ZAFAR GONDAL, ANOOSH (MD)
Entity type:Individual
Prefix:
First Name:ANOOSH
Middle Name:
Last Name:ZAFAR GONDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3900
Mailing Address - Country:US
Mailing Address - Phone:207-907-1000
Mailing Address - Fax:
Practice Address - Street 1:360 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3900
Practice Address - Country:US
Practice Address - Phone:207-907-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2023-09-05
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-04-14
Provider Licenses
StateLicense IDTaxonomies
MEMD26737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine