Provider Demographics
NPI:1124035886
Name:GUPTA, RAJENDRA PRASAD (MD)
Entity Type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:PRASAD
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 PENNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-1208
Mailing Address - Country:US
Mailing Address - Phone:609-882-5317
Mailing Address - Fax:609-538-8031
Practice Address - Street 1:1871 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-1208
Practice Address - Country:US
Practice Address - Phone:609-882-5317
Practice Address - Fax:609-538-8031
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32604207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ590267Medicare ID - Type Unspecified
E51257Medicare UPIN