1649428897 NPI number — UTPAL KANTI DUTTA MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649428897 NPI number — UTPAL KANTI DUTTA MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DUTTA

Provider First Name:

UTPAL

Provider Middle Name:

KANTI

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1649428897

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/06/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 2424

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PRINCE FREDERICK

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

20678-2424

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-535-2085

Provider Business Mailing Address Fax Number:

410-535-0404

Provider First Line Business Practice Location Address:

130 HOSPITAL RD STE 300

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PRINCE FREDERICK

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

20678-4057

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-535-4333

Provider Business Practice Location Address Fax Number:

410-535-3260

Provider Enumeration Date:

08/29/2008

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RN0300X , with the licence number:  D70833 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 01366238 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: 1649428897 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 1649428897 . This is a "KAISER PERMANENTE" identifier . This identifiers is of the category "OTHER".
• Identifier: 1649428897 . This is a "CARE IMPROVEMENT PLUS" identifier . This identifiers is of the category "OTHER".
• Identifier: 1649428897 . This is a "MARYLAND PHYSICIANS CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 1649428897 . This is a "COVENTRY HEALTH CARE OF DELAWARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 522300606 . This is a "PATUXENT NEPHROLOGY ASSOCIATES, LLC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 1649428897 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 1649428897 . This is a "UNITED HEALTHCARE, MAMSI, MDIPA, OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: F117 AND 0J48PA . This is a "CAREFIRST BLUECROSS BLUESHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 1649428897 . This is a "MULTIPLAN, PHCS" identifier . This identifiers is of the category "OTHER".
• Identifier: 418952301 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".