Provider Demographics
NPI:1346215605
Name:GUPTA, RAJ RANI (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:RANI
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:228 BILLERICA RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3604
Mailing Address - Country:US
Mailing Address - Phone:978-250-6100
Mailing Address - Fax:978-250-6002
Practice Address - Street 1:228 BILLERICA RD
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3604
Practice Address - Country:US
Practice Address - Phone:978-250-6100
Practice Address - Fax:978-250-6002
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA76787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA076787OtherTUFTS
MA0112623Medicaid
MAJ22907OtherBLUE CROSS
MAPV011OtherHARVARD PILGRIM
MA0112623Medicaid
MAY02775Medicare PIN