Provider Demographics
NPI:1285802504
Name:GUPTA, NEEL DEWAN (MD)
Entity type:Individual
Prefix:
First Name:NEEL
Middle Name:DEWAN
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 1:120 TERRY PKWY
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-2523
Mailing Address - Country:US
Mailing Address - Phone:504-362-7246
Mailing Address - Fax:
Practice Address - Street 1:120 TERRY PKWY
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-2523
Practice Address - Country:US
Practice Address - Phone:504-362-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPGY.2-TUL2085R0202X
LAMD.2020092085R0202X
MS221442085R0202X
NC2012-023102085R0202X
FLME1142922085R0202X
CAAFE1152422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1079758Medicaid