Healthcare Provider Details

I. General information

NPI: 1881738334
Provider Name (Legal Business Name): RISHI R. GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 THOMAS JOHNSON CT
FREDERICK MD
21702-4348
US

IV. Provider business mailing address

86 THOMAS JOHNSON CT
FREDERICK MD
21702-4348
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-8311
  • Fax: 301-694-3537
Mailing address:
  • Phone: 301-694-8311
  • Fax: 301-694-3537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD159847
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberD81720
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: