=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912776592
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED ENDOCRINOLOGY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/25/2023
-----------------------------------------------------
Last Update Date | 01/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15200 SHADY GROVE RD STE 202
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-297-3330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16506 HARBOUR TOWN DR
-----------------------------------------------------
City | ASHTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20861-4092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-535-6967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. ANURAG GUPTA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 301-297-3330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------