Healthcare Provider Details

I. General information

NPI: 1609458025
Provider Name (Legal Business Name): SAMYUKTHA GUTTHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

2929 ARCH ST FL 12
PHILADELPHIA PA
19104-2857
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax: 267-443-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD488531
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: