Provider Demographics
NPI:1992963144
Name:GONDY, GAUTHAMI (MD)
Entity type:Individual
Prefix:MRS
First Name:GAUTHAMI
Middle Name:
Last Name:GONDY
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 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:410-402-2379
Mailing Address - Fax:
Practice Address - Street 1:21170 ASHBY PONDS BLVD
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6128
Practice Address - Country:US
Practice Address - Phone:571-291-6131
Practice Address - Fax:571-291-6135
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP19014207R00000X
VA0101244685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine