Healthcare Provider Details

I. General information

NPI: 1972577005
Provider Name (Legal Business Name): SANDEEP GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH STREET WILMINGTON HOSPITAL, DEPARTMENT OF PSYCHIATRY
WILMINGTON DE
19801
US

IV. Provider business mailing address

501 W 14TH STREET WILMINGTON HOSPITAL, DEPARTMENT OF PSYCHIATRY
WILMINGTON DE
19801
US

V. Phone/Fax

Practice location:
  • Phone: 302-421-2100
  • Fax: 302-421-2121
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC10007149
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: