Provider Demographics
NPI:1053334649
Name:GUPTA, ANIL (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
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 1:206 E. BROWN ST.
Mailing Address - Street 2:POCONO HEALTHCARE MANAGEMENT-PROFESSIONAL CENTER
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-420-4951
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:500 PLAZA COURT, SUITE A
Practice Address - Street 2:PMC PHYSICIAN ASSOCIATES CARDIOLOGY
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8262
Practice Address - Country:US
Practice Address - Phone:570-424-9970
Practice Address - Fax:570-424-2899
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002251-1207RC0000X
PAMD-433778207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02652486Medicaid
NYI30439Medicare UPIN
NY02652486Medicaid