Provider Demographics
NPI:1093801060
Name:GUPTA, PRAVEEN KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:50 WEST EDMONSTON DRIVE
Mailing Address - Street 2:#202
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-762-0788
Mailing Address - Fax:301-762-3130
Practice Address - Street 1:50 WEST EDMONSTON DRIVE
Practice Address - Street 2:#202
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-762-0788
Practice Address - Fax:301-762-3130
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0037532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD068171700Medicaid
MD068171700Medicaid