Provider Demographics
NPI:1275510901
Name:GUPTA, SHASHI B (MD)
Entity Type:Individual
Prefix:
First Name:SHASHI
Middle Name:B
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 1:51339 NATIONAL RD E
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9119
Mailing Address - Country:US
Mailing Address - Phone:740-695-1210
Mailing Address - Fax:740-695-4344
Practice Address - Street 1:51339 NATIONAL RD E
Practice Address - Street 2:SUITE 12
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9119
Practice Address - Country:US
Practice Address - Phone:740-695-1210
Practice Address - Fax:740-695-4344
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076216G207R00000X
WV19728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2117417Medicaid
WV0003247000Medicaid
G93697Medicare UPIN
WV0003247000Medicaid
OH2117417Medicaid