Provider Demographics
NPI:1083041883
Name:GUPTA, ANKUR
Entity Type:Individual
Prefix:
First Name:ANKUR
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANGALAM RESIDENCY, ORCHID BLOCK A, FLAT 104
Mailing Address - Street 2:FATEHPURA
Mailing Address - City:UDAIPUR
Mailing Address - State:RAJASTHAN
Mailing Address - Zip Code:313001
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MANGALAM RESIDENCY, ORCHID BLOCK A, FLAT 104
Practice Address - Street 2:FATEHPURA
Practice Address - City:UDAIPUR
Practice Address - State:RAJASTHAN
Practice Address - Zip Code:313001
Practice Address - Country:IN
Practice Address - Phone:0091982-802-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program