Healthcare Provider Details

I. General information

NPI: 1326603275
Provider Name (Legal Business Name): NIKITA GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 HOAGIE DR
BEL AIR MD
21014-1884
US

IV. Provider business mailing address

611 S CHARLES ST UNIT 657
BALTIMORE MD
21230-3897
US

V. Phone/Fax

Practice location:
  • Phone: 315-842-7937
  • Fax:
Mailing address:
  • Phone: 315-842-7937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0094554
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: