Provider Demographics
NPI:1093886657
Name:GUPTA, SUNIL KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 KENT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3798
Mailing Address - Country:US
Mailing Address - Phone:301-724-7117
Mailing Address - Fax:
Practice Address - Street 1:625 KENT AVE STE 101
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3798
Practice Address - Country:US
Practice Address - Phone:301-724-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409051900Medicaid
MD753LMedicare ID - Type Unspecified
MD409051900Medicaid