Provider Demographics
NPI:1871971895
Name:GUPTA, SUMEET (MD)
Entity type:Individual
Prefix:DR
First Name:SUMEET
Middle Name:
Last Name:GUPTA
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 1:8136 OLD KEENE MILL RD STE B300
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1856
Mailing Address - Country:US
Mailing Address - Phone:703-451-6111
Mailing Address - Fax:703-451-6247
Practice Address - Street 1:8136 OLD KEENE MILL RD STE B300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1856
Practice Address - Country:US
Practice Address - Phone:703-451-6111
Practice Address - Fax:703-451-6247
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV27672207W00000X
VA0101274578207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program