MEDICARE: DR. MONIQUE GUPTA KUMAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	2013012520	MO
2	207NP0225X	Pediatric Dermatology Physician	ME127776	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821227133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONIQUE GUPTA KUMAR MD

Provider Business Mailing Address
First Line	:	615 E PRINCETON ST STE 416
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-1469
Country	:	US
Telephone Number	:	407-303-1687
Fax Number	:	407-303-1729

Provider Business Practice Location Address
First Line	:	615 E PRINCETON ST STE 416
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-1469
Country	:	US
Telephone Number	:	407-303-1687
Fax Number	:	407-303-1729

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	10/23/2016

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