Provider Demographics
NPI:1174637920
Name:GUPTA, ANJU (MD)
Entity Type:Individual
Prefix:
First Name:ANJU
Middle Name:
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 1:122 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601
Mailing Address - Country:US
Mailing Address - Phone:814-943-3600
Mailing Address - Fax:814-943-3675
Practice Address - Street 1:122 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-5202
Practice Address - Country:US
Practice Address - Phone:814-943-3600
Practice Address - Fax:814-943-3675
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019748770003Medicaid
PRH96981Medicare UPIN
PA074567PN6Medicare PIN