Provider Demographics
NPI:1003889601
Name:GUPTA, BRINDA TRIVEDI (MD)
Entity Type:Individual
Prefix:DR
First Name:BRINDA
Middle Name:TRIVEDI
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:SUITE 466
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-969-8989
Mailing Address - Fax:617-928-0178
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 466
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-969-8989
Practice Address - Fax:617-928-0178
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA152014208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G50625Medicare UPIN