Provider Demographics
NPI:1134146855
Name:GUPTA, NIRAV (DO)
Entity Type:Individual
Prefix:
First Name:NIRAV
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9074
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9074
Mailing Address - Country:US
Mailing Address - Phone:352-629-1979
Mailing Address - Fax:352-629-1924
Practice Address - Street 1:2640 SW 32ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7847
Practice Address - Country:US
Practice Address - Phone:352-629-1979
Practice Address - Fax:352-629-1924
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9535207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276069000Medicaid
FLDG5713OtherMEICARE RR GROUP NUMBER
FL24419OtherBCBS GROUP
FLP00442268OtherMEDICARE RR PTAN
FL56088OtherBCBS
FL5929150001Medicare NSC
I66326Medicare UPIN