Healthcare Provider Details

I. General information

NPI: 1942838081
Provider Name (Legal Business Name): NUPUR VIKRAM GULATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 07/15/2024
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 REYNOLDS ST STE 100
MONROE NC
28112-4375
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-289-5443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2022-01865
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2022-01865
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: