Healthcare Provider Details

I. General information

NPI: 1689092884
Provider Name (Legal Business Name): KAMINI GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2793 GERYVILLE PIKE
PENNSBURG PA
18073-2306
US

IV. Provider business mailing address

2793 GERYVILLE PIKE
PENNSBURG PA
18073-2306
US

V. Phone/Fax

Practice location:
  • Phone: 267-424-8200
  • Fax:
Mailing address:
  • Phone: 267-424-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD462329
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number390200000
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: