Provider Demographics
NPI:1215970058
Name:GUPTA, RAVINDRA D (MD)
Entity type:Individual
Prefix:DR
First Name:RAVINDRA
Middle Name:D
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 1:3300 GALLOWS RD
Mailing Address - Street 2:PHYSICIAN BILLING
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3307
Mailing Address - Country:US
Mailing Address - Phone:703-776-1110
Mailing Address - Fax:703-776-2917
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:PHYSICIAN BILLING
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-1110
Practice Address - Fax:703-776-2917
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238830208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H96426Medicare UPIN
DC018169I67Medicare PIN