Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101259822 | VA |
N | 2080P0210X | Pediatric Nephrologist | 0101259822 | VA |
NPI | 1295979896 |
---|---|
Provider Name | Dr. Nirupama Gupta |
First Address | Leesburg, VA 20176-3324 |
Second Address | Leesburg, VA 20176-3324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2009 |
Last Update Date | 12/01/2022 |