Provider Demographics
NPI:1326084377
Name:GUPTA, AKSHAY S (MD)
Entity type:Individual
Prefix:
First Name:AKSHAY
Middle Name:S
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 1:445 HARLOW RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1341
Mailing Address - Country:US
Mailing Address - Phone:413-027-7715
Mailing Address - Fax:
Practice Address - Street 1:445 HARLOW RD STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1341
Practice Address - Country:US
Practice Address - Phone:541-302-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD601664332085R0202X
ORMD256652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8420564Medicaid
AKMD6356RMedicaid
AKMD6355RMedicaid
OR277978Medicaid
OR131070Medicare PIN
ORP00228097Medicare PIN
I04618Medicare UPIN
ORP00219188Medicare PIN
WA8420564Medicaid
AKMD6355RMedicaid
OR135704Medicare PIN
OR131071Medicare PIN