Provider Demographics
NPI:1598761207
Name:GUPTA, SAMBIT KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SAMBIT
Middle Name:KUMAR
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 1:12603 OLD WICK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1937
Mailing Address - Country:US
Mailing Address - Phone:210-277-8989
Mailing Address - Fax:210-277-8989
Practice Address - Street 1:12603 OLD WICK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1937
Practice Address - Country:US
Practice Address - Phone:210-277-8989
Practice Address - Fax:210-277-8989
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.12239R207P00000X
LA12239R207R00000X
NC2006-00415207R00000X
TXM3566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1155063Medicaid
TX8G8691Medicare ID - Type Unspecified
LAG62404Medicare UPIN
LA1155063Medicaid