Provider Demographics
NPI:1174073332
Name:GOWDA, PAVITHRA (PA)
Entity type:Individual
Prefix:
First Name:PAVITHRA
Middle Name:
Last Name:GOWDA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PAVITHRA
Other - Middle Name:N
Other - Last Name:RAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, STE. 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-7939
Mailing Address - Country:US
Mailing Address - Phone:703-914-8000
Mailing Address - Fax:
Practice Address - Street 1:19735 GERMANTOWN RD STE 360
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1232
Practice Address - Country:US
Practice Address - Phone:301-528-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant