Provider Demographics
NPI:1366460651
Name:GUPTA, DOLLY (MD)
Entity Type:Individual
Prefix:
First Name:DOLLY
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 1:424 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4428
Mailing Address - Country:US
Mailing Address - Phone:757-934-2200
Mailing Address - Fax:757-934-0220
Practice Address - Street 1:424 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4428
Practice Address - Country:US
Practice Address - Phone:757-934-2200
Practice Address - Fax:757-934-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052003208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics