Provider Demographics
NPI:1073833554
Name:GUPTA, KAVITA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:388 POMPTON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1814
Mailing Address - Country:US
Mailing Address - Phone:973-302-5630
Mailing Address - Fax:973-787-3242
Practice Address - Street 1:388 POMPTON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1814
Practice Address - Country:US
Practice Address - Phone:973-302-5630
Practice Address - Fax:973-787-3242
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09261300207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine