1558478693 NPI number — SAMIR K GUPTA MD

Table of content: SAMIR K GUPTA MD (NPI 1558478693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558478693 NPI number — SAMIR K GUPTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
SAMIR
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1558478693
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11510 GEORGIA AVE
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
WHEATON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-946-5100
Provider Business Mailing Address Fax Number:
301-929-0348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 IRVING ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-946-5100
Provider Business Practice Location Address Fax Number:
301-929-0348
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD22123 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200113 . This is a "KAISER" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 2495270 . This is a "AETNA HMO" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 441031 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0075 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 4682356004 . This is a "CIGNA HMO" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 5329472 . This is a "AETNA NON HMO" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 5704952 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 501323 . This is a "NCPPO" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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