Provider Demographics
NPI:1144514340
Name:GU, JUNYAN (MD, PHD)
Entity type:Individual
Prefix:
First Name:JUNYAN
Middle Name:
Last Name:GU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD STE 125
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6799
Mailing Address - Country:US
Mailing Address - Phone:301-714-4335
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 125
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6799
Practice Address - Country:US
Practice Address - Phone:301-714-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4743062086S0129X
MDD867142086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery