Provider Demographics
NPI:1407313497
Name:GUPTON, MARCO (DO)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:GUPTON
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 CANYON SHADOWS CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-1005
Mailing Address - Country:US
Mailing Address - Phone:704-640-6006
Mailing Address - Fax:
Practice Address - Street 1:130 MASON FARM RD # 7055
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-8262
Practice Address - Country:US
Practice Address - Phone:919-966-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-00904207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine