Basic Information
| Provider Information | |||||||||
| NPI: | 1477983815 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GOVIL | ||||||||
| FirstName: | NIDHI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11350 MCCORMICK ROAD EXECUTIVE PLAZA 1 | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103291070 | ||||||||
| FaxNumber: | 4103291054 | ||||||||
| Practice Location | |||||||||
| Address1: | 19500 SANDRIDGE WAY STE 100 | ||||||||
| Address2: | |||||||||
| City: | LANSDOWNE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201763689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037384344 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2013 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110004303 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.