Provider Demographics
NPI:1073622072
Name:GUPTA, MONIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E MAIN ST
Mailing Address - Street 2:404 KELWAY PLAZA
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7128
Mailing Address - Country:US
Mailing Address - Phone:302-737-6041
Mailing Address - Fax:302-737-5598
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:404 KELWAY PLAZA
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7128
Practice Address - Country:US
Practice Address - Phone:302-737-6041
Practice Address - Fax:302-737-5598
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10008120174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE205465821OtherBLUE CROSS BLUE SHIELD OF DELAWARE
DE1073622072Medicaid
DE205465821OtherBLUE CROSS BLUE SHIELD OF DELAWARE