Healthcare Provider Details

I. General information

NPI: 1699067520
Provider Name (Legal Business Name): SHRISTI NEUPANE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 PULASKI HWY STE 207
HAVRE DE GRACE MD
21078
US

IV. Provider business mailing address

2027 PULASKI HWY STE 207
HAVRE DE GRACE MD
21078-2147
US

V. Phone/Fax

Practice location:
  • Phone: 443-843-6100
  • Fax: 443-843-6130
Mailing address:
  • Phone: 443-843-6100
  • Fax: 443-843-6130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301104622
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number4301104622
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: