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: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ST. PATRICK'S DRIVE
WALDORF MD
20603-4527
US

IV. Provider business mailing address

24035 THREE NOTCH RD
HOLLYWOOD MD
20636-4871
US

V. Phone/Fax

Practice location:
  • Phone: 301-705-7870
  • Fax: 301-705-7628
Mailing address:
  • Phone: 301-373-7900
  • Fax: 301-373-6900

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: