Provider Demographics
NPI:1346281839
Name:GUPTA, PRIYANKA (MD)
Entity Type:Individual
Prefix:MS
First Name:PRIYANKA
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 1:212 HUNTERS VILLAGE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-5250
Mailing Address - Country:US
Mailing Address - Phone:830-625-7612
Mailing Address - Fax:830-625-9357
Practice Address - Street 1:212 HUNTERS VILLAGE
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5250
Practice Address - Country:US
Practice Address - Phone:830-625-7612
Practice Address - Fax:830-625-9357
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2629174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178952101Medicaid
TX178952101Medicaid
I14680Medicare UPIN
TX8G2978Medicare ID - Type Unspecified