Provider Demographics
NPI:1063476935
Name:GUPTA, J. D (MD)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:D
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 1:2704 MEDICAL OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9460
Mailing Address - Country:US
Mailing Address - Phone:919-736-4724
Mailing Address - Fax:919-736-1677
Practice Address - Street 1:2704 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9460
Practice Address - Country:US
Practice Address - Phone:919-736-4724
Practice Address - Fax:919-736-1677
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC019694174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8937894Medicaid
NC37894OtherBCBS
NC37894OtherBCBS
NC8937894Medicaid
NCD62785Medicare UPIN