Healthcare Provider Details

I. General information

NPI: 1609163039
Provider Name (Legal Business Name): NEHA GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 N CENTER DR STE 206
NORFOLK VA
23502-4008
US

IV. Provider business mailing address

1060 FIRST COLONIAL RD
VIRGINIA BEACH VA
23454-3002
US

V. Phone/Fax

Practice location:
  • Phone: 757-821-6310
  • Fax:
Mailing address:
  • Phone: 757-395-2323
  • Fax: 757-395-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101264907
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101264907
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: