Provider Demographics
NPI:1528420387
Name:GOUGIAN, RACHEL L (DO)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:L
Last Name:GOUGIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6300 BALTIMORE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2123
Mailing Address - Country:US
Mailing Address - Phone:301-200-0960
Mailing Address - Fax:250-999-6514
Practice Address - Street 1:6300 BALTIMORE AVE STE 1
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:MD
Practice Address - Zip Code:20782-2123
Practice Address - Country:US
Practice Address - Phone:301-200-0960
Practice Address - Fax:250-999-6514
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO034847207Q00000X
MDH92585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine