Provider Demographics
NPI:1073569232
Name:GUPTA, VINOD K (MD)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:K
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 1:67 PROSPECT AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2907
Mailing Address - Country:US
Mailing Address - Phone:518-828-2565
Mailing Address - Fax:
Practice Address - Street 1:67 PROSPECT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2907
Practice Address - Country:US
Practice Address - Phone:518-828-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-194179207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01593360Medicaid
000401540001OtherBS OF NENY
10000824OtherCDPHP
30652OtherGHI HMO
805872OtherBC/BS
1349211OtherUNITED HEALTHCARE
040426007287OtherFIDELIS
P920287OtherOXFORD
0061801OtherGHI PPO
195191OtherWELLCARE
277682OtherMVP
GA290008564Medicare PIN
NYG08499Medicare UPIN
P920287OtherOXFORD
000401540001OtherBS OF NENY
30652OtherGHI HMO