Healthcare Provider Details

I. General information

NPI: 1609684794
Provider Name (Legal Business Name): DIPA GAUTAM NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIPA GAUTAM NP

II. Dates (important events)

Enumeration Date: 12/21/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOWARD UNIVERSITY HOSPITAL 2041 GEORGIA AVENUE NW
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

535 BEACON HILL TER
GAITHERSBURG MD
20878-1980
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-1141
  • Fax:
Mailing address:
  • Phone: 240-938-7604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP1039997
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: