Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | MT201074 | PA |
Y | 208000000X | Pediatrician | MD454516 | PA |
NPI | 1548523855 |
---|---|
Provider Name | Katherine Gupta |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 14/06/2018 |