Provider Demographics
NPI:1649428897
Name:DUTTA, UTPAL KANTI (MD)
Entity type:Individual
Prefix:
First Name:UTPAL
Middle Name:KANTI
Last Name:DUTTA
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:PO BOX 2424
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-2424
Mailing Address - Country:US
Mailing Address - Phone:410-535-2085
Mailing Address - Fax:410-535-0404
Practice Address - Street 1:130 HOSPITAL RD STE 300
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4057
Practice Address - Country:US
Practice Address - Phone:410-535-4333
Practice Address - Fax:410-535-3260
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD70833207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
01366238OtherAMERIGROUP
1649428897OtherTRICARE
1649428897OtherKAISER PERMANENTE
1649428897OtherCARE IMPROVEMENT PLUS
1649428897OtherMARYLAND PHYSICIANS CARE
1649428897OtherCOVENTRY HEALTH CARE OF DELAWARE
MD522300606OtherPATUXENT NEPHROLOGY ASSOCIATES, LLC
1649428897OtherCIGNA
1649428897OtherUNITED HEALTHCARE, MAMSI, MDIPA, OPTIMUM CHOICE
F117 AND 0J48PAOtherCAREFIRST BLUECROSS BLUESHIELD
1649428897OtherMULTIPLAN, PHCS
MD418952301Medicaid
1649428897OtherCIGNA