Provider Demographics
NPI:1134475569
Name:GUPTA, ARCHANA ANIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:ANIL
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9980 CENTRAL PARK BLVD N STE 118
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1703
Mailing Address - Country:US
Mailing Address - Phone:561-931-2655
Mailing Address - Fax:561-931-2657
Practice Address - Street 1:9980 CENTRAL PARK BLVD N STE 118
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1703
Practice Address - Country:US
Practice Address - Phone:561-931-2655
Practice Address - Fax:561-931-2657
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130980207W00000X
FLTRN16976207W00000X
MN61941207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME130980OtherMEDICAL LICENSE