Provider Demographics
NPI:1225031552
Name:GUPTA, RAJAT (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJAT
Middle Name:
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 1:4407 BEE CAVE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6405
Mailing Address - Country:US
Mailing Address - Phone:512-330-0961
Mailing Address - Fax:512-330-0962
Practice Address - Street 1:4407 BEE CAVE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6405
Practice Address - Country:US
Practice Address - Phone:512-330-0961
Practice Address - Fax:512-330-0962
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK07942084N0400X, 2084P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
83410KMedicare ID - Type Unspecified
F92406Medicare UPIN