Provider Demographics
NPI:1235462169
Name:GUPTA, ASHISH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1033 GREENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-4443
Mailing Address - Country:US
Mailing Address - Phone:617-794-6865
Mailing Address - Fax:239-256-5654
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-650-7031
Practice Address - Fax:508-650-7897
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2539582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110098756AMedicaid