Healthcare Provider Details

I. General information

NPI: 1649700766
Provider Name (Legal Business Name): SUMIT GUPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS STREET BRIGHAM AND WOMEN'S HOSPITAL
BOSTON MA
02115
US

IV. Provider business mailing address

1620 TREMONT ST RADIOLOGY ADMINISTRATION
BOSTON MA
02120
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-8322
  • Fax: 617-582-6056
Mailing address:
  • Phone: 617-732-8098
  • Fax: 617-525-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number283510
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: