Provider Demographics
NPI:1033323399
Name:GUPTA, ANUJ (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUJ
Middle Name:
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 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-7877
Mailing Address - Fax:410-328-2255
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-7877
Practice Address - Fax:410-328-2255
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD67944207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1033323399Medicaid
MDS062-0336OtherCAREFIRST BC /BS REGIONAL
MD936790-01OtherCAREFIRST BC/BS
MD415359600Medicaid
MDS062-0336OtherCAREFIRST BC /BS REGIONAL
MD134274Y3WMedicare PIN