Provider Demographics
NPI:1972093474
Name:GUPTA, ANJALIKA (MD)
Entity type:Individual
Prefix:
First Name:ANJALIKA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:
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:SCRANTON PRIMARY HEALTH CARE CENTER, INC.
Mailing Address - Street 2:959 WYOMING AVE
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-3023
Mailing Address - Country:US
Mailing Address - Phone:570-344-3517
Mailing Address - Fax:570-344-9683
Practice Address - Street 1:959 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-3023
Practice Address - Country:US
Practice Address - Phone:570-344-9684
Practice Address - Fax:570-969-0968
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD479741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine