Provider Demographics
NPI:1104828441
Name:GUPTA, ANURAG (MD)
Entity type:Individual
Prefix:
First Name:ANURAG
Middle Name:
Last Name:GUPTA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 SHADY GROVE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3218
Mailing Address - Country:US
Mailing Address - Phone:301-297-3330
Mailing Address - Fax:877-569-2361
Practice Address - Street 1:15200 SHADY GROVE RD STE 202
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3218
Practice Address - Country:US
Practice Address - Phone:301-297-3330
Practice Address - Fax:877-569-2361
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060948207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404064300Medicaid
MD014012Medicare ID - Type Unspecified
MD404064300Medicaid