Provider Demographics
NPI:1306128558
Name:GUPTA, PARONI (NP-C)
Entity type:Individual
Prefix:
First Name:PARONI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 POND WAY
Mailing Address - Street 2:STE 170
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5596
Mailing Address - Country:US
Mailing Address - Phone:571-542-4950
Mailing Address - Fax:571-285-1160
Practice Address - Street 1:1936 OPITZ BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3360
Practice Address - Country:US
Practice Address - Phone:703-491-7744
Practice Address - Fax:703-492-1046
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001210984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily