Healthcare Provider Details

I. General information

NPI: 1649428897
Provider Name (Legal Business Name): UTPAL KANTI DUTTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HOSPITAL RD STE 300
PRINCE FREDERICK MD
20678-4057
US

IV. Provider business mailing address

PO BOX 2424
PRINCE FREDERICK MD
20678-2424
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-4333
  • Fax: 410-535-3260
Mailing address:
  • Phone: 410-535-2085
  • Fax: 410-535-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD70833
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: