Provider Demographics
NPI:1225032931
Name:GUPTA, ABHILASHA (MD)
Entity Type:Individual
Prefix:DR
First Name:ABHILASHA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABHILASHA
Other - Middle Name:
Other - Last Name:MAHAWAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13376 RESEARCH BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3237
Mailing Address - Country:US
Mailing Address - Phone:512-219-0129
Mailing Address - Fax:512-219-0393
Practice Address - Street 1:2700 W PECAN ST STE 102
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3069
Practice Address - Country:US
Practice Address - Phone:512-421-3750
Practice Address - Fax:512-421-3751
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5355207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158869102Medicaid
TXTXB150644OtherWELLMED PTAN
TX158869104Medicaid
TXH79865Medicare UPIN