Individual
SHAKUNMALA GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9650 SANTIAGO RD STE 6, COLUMBIA, MD 21045-3960
(410) 992-7004
(410) 992-1657
Mailing address
PO BOX 6303, ELLICOTT CITY, MD 21042-0303
(410) 992-7004
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0053150
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
241500300
—
MD
Enumeration date
09/16/2006
Last updated
11/12/2024
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