Provider Demographics
NPI:1275513681
Name:GUPTA, GOPAL K (MD)
Entity Type:Individual
Prefix:DR
First Name:GOPAL
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:799 CONCORD AVE # DOOR4
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1048
Mailing Address - Country:US
Mailing Address - Phone:617-491-5111
Mailing Address - Fax:617-491-5222
Practice Address - Street 1:799 CONCORD AVE # DOOR4
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1048
Practice Address - Country:US
Practice Address - Phone:617-491-5111
Practice Address - Fax:617-491-5222
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2013-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1529502080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3203395Medicaid
MA110062097AMedicaid
MA110062097AMedicaid
MA3203395Medicaid