Provider Demographics
NPI:1033766480
Name:GUPTA, ASHWIN K (PA)
Entity Type:Individual
Prefix:
First Name:ASHWIN
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:M
Credentials:PA
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3801 FILBERT ST.
Mailing Address - Street 2:MEDICAL ARTS BUILDING 1ST FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-9908
Mailing Address - Fax:215-243-4658
Practice Address - Street 1:3801 FILBERT ST.
Practice Address - Street 2:MEDICAL ARTS BUILDING 1ST FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-9908
Practice Address - Fax:215-243-4658
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00546200363A00000X
PAMA060922363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant