Individual
TANKALA SHANTAL GUPTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
110 IRVING ST NW, WASHINGTON, DC 20010-3017
(832) 212-0628
Mailing address
2400 16TH ST NW APT 607, WASHINGTON, DC 20009-6629
(832) 212-0628
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD045038
DC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/15/2014
Last updated
12/14/2017
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