Individual
DR. CHRYSOLOGUE GAKUBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 RESERVOIR CIR, SUITE 105, PIKESVILLE, MD 21208-6393
(410) 653-1822
(410) 653-1857
Mailing address
5401 OLD COURT RD, ATTN: CREDENTIALING, RANDALLSTOWN, MD 21133-5103
(410) 601-5524
(410) 601-8946
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
D15533
MD
207RC0000X
Cardiovascular Disease Physician
Primary
D15533
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030281300
—
MD
01
—
60061888
R/R MEDICARE PROVIDER #
MD
Enumeration date
09/28/2006
Last updated
11/28/2007
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