Healthcare Provider Details

I. General information

NPI: 1669801619
Provider Name (Legal Business Name): GEETIKA GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2013
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 CHARTER DR STE 410
COLUMBIA MD
21044-3276
US

IV. Provider business mailing address

10710 CHARTER DR STE 410
COLUMBIA MD
21044-3276
US

V. Phone/Fax

Practice location:
  • Phone: 301-953-2080
  • Fax:
Mailing address:
  • Phone: 301-953-2080
  • Fax: 203-776-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0094579
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: