Healthcare Provider Details

I. General information

NPI: 1811966690
Provider Name (Legal Business Name): RAKHI GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200E 33RD ST 466
BALTIMORE MD
21218-3322
US

IV. Provider business mailing address

PO BOX 1647
OWINGS MILLS MD
21117-1664
US

V. Phone/Fax

Practice location:
  • Phone: 410-243-6224
  • Fax: 410-243-7222
Mailing address:
  • Phone: 410-243-6224
  • Fax: 410-243-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0063566
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: