1942485321 NPI number — DR. SUMMIT GUPTA M.D.

Table of content: DR. SUMMIT GUPTA M.D. (NPI 1942485321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942485321 NPI number — DR. SUMMIT GUPTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
SUMMIT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1942485321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10205 WINCOPIN CIR
Provider Second Line Business Mailing Address:
UNIT 302
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-3433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-421-6815
Provider Business Mailing Address Fax Number:
410-203-1897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 BULLARD CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
290-321-9575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2008

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: 208M00000X , with the licence number:  MD432933 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 313M00000X , with the licence number: D0068890 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: D0068890 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00688341-MERCER . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1022457110002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3582382000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0248100-00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102245711 0003-LOWER , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2082417 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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