Provider Demographics
NPI:1114075785
Name:GUPTA, MAYURI P (MD)
Entity Type:Individual
Prefix:
First Name:MAYURI
Middle Name:P
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAYURI
Other - Middle Name:
Other - Last Name:PATNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5340 N FEDERAL HWY STE 110
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7058
Mailing Address - Country:US
Mailing Address - Phone:954-425-2480
Mailing Address - Fax:954-428-2904
Practice Address - Street 1:5340 N FEDERAL HWY STE 110
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7058
Practice Address - Country:US
Practice Address - Phone:954-425-2480
Practice Address - Fax:954-428-2904
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429729207R00000X
FLME 109736207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine