Provider Demographics
NPI:1003052945
Name:GUPTA, CHHAVI (MD)
Entity Type:Individual
Prefix:
First Name:CHHAVI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 S HABANA AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4181
Mailing Address - Country:US
Mailing Address - Phone:813-388-1732
Mailing Address - Fax:813-864-9292
Practice Address - Street 1:508 S HABANA AVE.
Practice Address - Street 2:SUITE 270
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3718
Practice Address - Country:US
Practice Address - Phone:813-388-1732
Practice Address - Fax:813-864-9292
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-24
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115872207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106046200Medicaid