Provider Demographics
NPI:1972554020
Name:GUPTA, RAKESH VARDHAN (MD)
Entity type:Individual
Prefix:
First Name:RAKESH
Middle Name:VARDHAN
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:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-0148
Mailing Address - Country:US
Mailing Address - Phone:732-240-7777
Mailing Address - Fax:732-240-7710
Practice Address - Street 1:20 HOSPITAL DR
Practice Address - Street 2:SUITE 12 B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6434
Practice Address - Country:US
Practice Address - Phone:732-240-7777
Practice Address - Fax:732-240-7710
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08323100207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology