Provider Demographics
NPI:1215929138
Name:GUPTA, NEENA R (DO,)
Entity type:Individual
Prefix:DR
First Name:NEENA
Middle Name:R
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3453
Mailing Address - Country:US
Mailing Address - Phone:954-968-4000
Mailing Address - Fax:954-968-4099
Practice Address - Street 1:5430 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33073-3453
Practice Address - Country:US
Practice Address - Phone:954-968-4000
Practice Address - Fax:954-968-4099
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064078600OtherR ACCESS HEALTH SOLUTIONS BROWARD
FL80147OtherBLUE CROSS BLUE SHIELD OF FL
FL064078600OtherACCESS HEALTH ADMINISTRATORS
FL04162OtherWELLCARE
FL04162OtherSTAYWELL
FL064078600Medicaid
FL212774OtherAVMED
FL80147XMedicare PIN
FL064078600OtherACCESS HEALTH ADMINISTRATORS