Id Doc LLC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

ID DOC LLC

Practice address

410 Foulk Rd Ste 105
Wilmington, DE 19803-3835

Phone

(302) 295-9300

Fax

(302) 384-7162

NPI assigned

Dec 21, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Maya Gupta, MDNPI 1811011646

Title

Owner

Phone

(302) 295-9300

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DE

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maya Gupta, M.D.

  • Infectious Disease Physician
  • Newark, DE
  • NPI 1811011646
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1902518939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 PENNOCK DR",
            "city": "GARNET VALLEY",
            "state": "PA",
            "postal_code": "190601400",
            "telephone_number": "302-295-9300",
            "fax_number": "302-384-7162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 FOULK RD STE 105",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198033835",
            "telephone_number": "302-295-9300",
            "fax_number": "302-384-7162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ID DOC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-21",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "MAYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "302-295-9300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ejike Kingsley Ibekaku, PMHNP-BC
• Mohamed Ibrahim
• Icare-Institute of Care Advocacy Research and Education LLC
• Jessica Ice, RDN
• Steven Robert Ickes, PT
• Ierardi Vascular Clinic LLC
• Jane A Ierardi, MD
• Ieso Digital Health
• Erica Iffland, M.S., CCC-SLP
• Erin M Igo, DPT

• Infectious Disease Physician in Wilmington, DE
• Providers in Wilmington, DE by specialty
• Infectious Disease Physician in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.