Provider Demographics
NPI:1538246061
Name:CHABLANI, GUL (MD)
Entity type:Individual
Prefix:
First Name:GUL
Middle Name:
Last Name:CHABLANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11314 CORAL GABLES DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3803
Mailing Address - Country:US
Mailing Address - Phone:301-468-2520
Mailing Address - Fax:301-468-6762
Practice Address - Street 1:11119 ROCKVILLE PIKE STE 401
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3156
Practice Address - Country:US
Practice Address - Phone:301-468-2520
Practice Address - Fax:301-468-6762
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42518207R00000X, 207RG0300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00085463OtherRAIL ROAD MEDICARE
MD501377OtherNC PPO
MD52513701OtherCAREFIRST BLUESHIELD
MD07088OtherAMERIGROUP
DC6503-0001OtherCAREFIRSR BLUESHIELD
MD751961300Medicaid
DCP00085463OtherRAIL ROAD MEDICARE
MD501377OtherNC PPO