Provider Demographics
NPI:1326363870
Name:GUPTA, ALKA (MD)
Entity Type:Individual
Prefix:
First Name:ALKA
Middle Name:
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 1:3230 PENNSYLVANIA AVE SE STE 205
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3731
Mailing Address - Country:US
Mailing Address - Phone:202-796-9775
Mailing Address - Fax:
Practice Address - Street 1:3230 PENNSYLVANIA AVE SE STE 205
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3731
Practice Address - Country:US
Practice Address - Phone:202-796-9775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-28
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270550207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03625312Medicaid
NY03625312Medicaid