Provider Demographics
NPI:1114997962
Name:GUPTA, RAJAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAJAN
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 1:100 SPRINGDALE RD STE B5
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3366
Mailing Address - Country:US
Mailing Address - Phone:856-482-7246
Mailing Address - Fax:856-482-7245
Practice Address - Street 1:100 SPRINGDALE RD STE B5
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3366
Practice Address - Country:US
Practice Address - Phone:856-482-7246
Practice Address - Fax:856-482-7245
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA077138002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ102453VHYMedicare PIN
H88074Medicare UPIN