Provider Demographics
NPI:1326268475
Name:GUPTA, OMESH PARKASH (MD)
Entity Type:Individual
Prefix:
First Name:OMESH
Middle Name:PARKASH
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4060 BUTLER PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1560
Mailing Address - Country:US
Mailing Address - Phone:800-331-6634
Mailing Address - Fax:267-420-1360
Practice Address - Street 1:4060 BUTLER PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1560
Practice Address - Country:US
Practice Address - Phone:800-331-6634
Practice Address - Fax:267-420-1360
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0009162207W00000X
NJ25MA08900500207W00000X, 207WX0107X
PAMD431770207WX0107X, 207W00000X
DECI-0009162207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA218325EV6Medicare PIN
DE219266ZCWYMedicare PIN
NJ221001AHDMedicare PIN
PA101937787-0001Medicaid