Provider Demographics
NPI:1558390245
Name:GUPTA, URMILA (MD)
Entity type:Individual
Prefix:DR
First Name:URMILA
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 1:3201 BROKEN BOW WAY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3390
Mailing Address - Country:US
Mailing Address - Phone:432-349-4390
Mailing Address - Fax:
Practice Address - Street 1:3201 BROKEN BOW WAY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3390
Practice Address - Country:US
Practice Address - Phone:432-349-4390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H3961OtherBCBS TX
TX127910101OtherFIRSTCARE HMO
TX5556033OtherAETNA
TX121440OtherSUPERIOR HEALTHPLAN
TX126877308Medicaid
TX5556033OtherAETNA
TX8A2815Medicare ID - Type UnspecifiedMEDICARE