Provider Demographics
NPI:1003810623
Name:GUPTA, RUPAL PATEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:RUPAL
Middle Name:PATEL
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:RUPAL
Other - Middle Name:NARENDRA
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:3995 MONTGLENN TRCE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7373
Mailing Address - Country:US
Mailing Address - Phone:770-418-0456
Mailing Address - Fax:770-418-1603
Practice Address - Street 1:4355 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE 520
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6048
Practice Address - Country:US
Practice Address - Phone:770-418-0456
Practice Address - Fax:770-418-1603
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000958213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52026903OtherBCBS
GA260427OtherCOVENTRY
GA7540578OtherAETNA
GA948040303DMedicaid
GA5363600001OtherCIGNA DME
GA226592810OtherUHC
GA7305891OtherCIGNA
GA948040303DMedicaid
GA260427OtherCOVENTRY