Provider Demographics
NPI:1093789869
Name:GUPTA, SURESH K (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9801 GEORGIA AVE
Mailing Address - Street 2:STE. 220
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5276
Mailing Address - Country:US
Mailing Address - Phone:301-681-5922
Mailing Address - Fax:301-681-6463
Practice Address - Street 1:9801 GEORGIA AVE
Practice Address - Street 2:STE. 220
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-681-5922
Practice Address - Fax:301-681-6463
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD431431001Medicaid
MD431431001Medicaid
C88865Medicare UPIN