Provider Demographics
NPI:1366419566
Name:GUPTA, RENUKA (MD)
Entity type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 HANOVER PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3626
Mailing Address - Country:US
Mailing Address - Phone:301-345-7885
Mailing Address - Fax:301-345-7422
Practice Address - Street 1:7215 HANOVER PKWY STE D
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3626
Practice Address - Country:US
Practice Address - Phone:301-345-7885
Practice Address - Fax:301-345-7422
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD20727207R00000X
DC9348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD546771300Medicaid
MDC62496Medicare UPIN
MDG01868R01Medicare ID - Type Unspecified