Provider Demographics
NPI:1942485321
Name:GUPTA, SUMMIT (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMMIT
Middle Name:
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 1:10205 WINCOPIN CIR
Mailing Address - Street 2:UNIT 302
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3433
Mailing Address - Country:US
Mailing Address - Phone:443-421-6815
Mailing Address - Fax:410-203-1897
Practice Address - Street 1:137 BULLARD CIR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3816
Practice Address - Country:US
Practice Address - Phone:290-321-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432933208M00000X
MDD0068890313M00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00688341-MERCEROtherRAILROAD MEDICARE
PA1022457110002Medicaid
PA3582382000OtherKEYSTONE HEALTH PLAN EAST
MD0248100-00Medicaid
PA102245711 0003-LOWERMedicaid
PA2082417OtherHIGHMARK BLUE SHIELD
PA142793X9JMedicare PIN
PA2082417OtherHIGHMARK BLUE SHIELD
NJ121857XPFMedicare PIN
PA1022457110002Medicaid
MD161011Medicare PIN