Provider Demographics
NPI:1962454835
Name:GUPTA, NITIN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:NITIN
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 DRESSER CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7327
Mailing Address - Country:US
Mailing Address - Phone:919-878-4060
Mailing Address - Fax:919-256-0499
Practice Address - Street 1:1101 DRESSER CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7327
Practice Address - Country:US
Practice Address - Phone:919-878-4060
Practice Address - Fax:919-256-0499
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00033207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910128Medicaid
NC5910128Medicaid