Provider Demographics
NPI:1225089725
Name:GUPTA, RAJEEV (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJEEV
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 1:1621 W MORRIS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2832
Mailing Address - Country:US
Mailing Address - Phone:423-317-7412
Mailing Address - Fax:423-317-7415
Practice Address - Street 1:1621 W MORRIS BLVD STE C
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2832
Practice Address - Country:US
Practice Address - Phone:423-317-7412
Practice Address - Fax:423-317-7415
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000035645207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3879184Medicaid
TN080190473OtherRAILROAD MEDICARE
TN3879184Medicare PIN