Healthcare Provider Details

I. General information

NPI: 1588028799
Provider Name (Legal Business Name): NAEHA GUPTA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 WALNUT ST STE 950
PHILADELPHIA PA
19102-3628
US

IV. Provider business mailing address

401 ROUTE 73 N STE 320
MARLTON NJ
08053-3426
US

V. Phone/Fax

Practice location:
  • Phone: 267-273-1196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS020576
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: