Provider Demographics
NPI:1184675621
Name:GUPTA, ATEFEH (MD)
Entity Type:Individual
Prefix:
First Name:ATEFEH
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 1:6305 INNISBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059
Mailing Address - Country:US
Mailing Address - Phone:502-228-9660
Mailing Address - Fax:
Practice Address - Street 1:4004 DUPONT CIRCLE
Practice Address - Street 2:STE 230
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-893-1333
Practice Address - Fax:502-899-9576
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37643174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH51126Medicare UPIN