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General NPI Number Information
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NPI Number | 1881062404
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Entity Type | Organization
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Legal Business Name | BAYSIDE GYNECOLOGY OF MARYLAND, LLC
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 200 E 33RD ST SUITE 466
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City | BALTIMORE
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State | MD
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Zip | 21218-3322
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Country | US
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Telephone | 410-243-6224
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Fax | 410-243-7222
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Provider Business Mailing Address
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Address Line | PO BOX 1647
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City | OWINGS MILLS
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State | MD
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Zip | 21117-1664
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Country | US
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Telephone | 410-243-6224
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Fax | 410-243-7222
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAKHI GUPTA
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Credential | M.D.
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Telephone | 410-243-6224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | D0063566
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License Number State | MD
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