Healthcare Provider Details

I. General information

NPI: 1548523855
Provider Name (Legal Business Name): KATHERINE GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE KNAPP M.D.

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BOULEVARD DIVISION OF EMERGENCY MEDICINE
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

100 E PENN SQ 9TH FL
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1959
  • Fax:
Mailing address:
  • Phone: 267-425-9234
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberMT201074
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD454516
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: