Provider Demographics
NPI:1841299138
Name:GUPTA, ANAND (MD, FACG)
Entity type:Individual
Prefix:DR
First Name:ANAND
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD, FACG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 N DUPONT SQ
Mailing Address - Street 2:9 A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4612
Mailing Address - Country:US
Mailing Address - Phone:502-893-7744
Mailing Address - Fax:502-893-7741
Practice Address - Street 1:1003N DUPONT SQ 9A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-893-7744
Practice Address - Fax:502-893-7741
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33458207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50021990OtherPASSPORT HEALTH
KY64343585Medicaid
KY65917932Medicaid
KY65917932Medicaid
KYDH1808Medicare PIN
KY50021990OtherPASSPORT HEALTH
KY1782801Medicare PIN
KY1782802Medicare PIN
KY64343585Medicaid