Provider Demographics
NPI:1376507251
Name:GUPTA, GOOL K (MD)
Entity Type:Individual
Prefix:DR
First Name:GOOL
Middle Name:K
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 1:2704 MEDICAL OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9460
Mailing Address - Country:US
Mailing Address - Phone:919-736-4724
Mailing Address - Fax:919-736-1677
Practice Address - Street 1:2704 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9460
Practice Address - Country:US
Practice Address - Phone:919-736-4724
Practice Address - Fax:919-736-1677
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8937893Medicaid
NC37893OtherBCBS
NCC84226Medicare UPIN
NC8937893Medicaid
NC206876AMedicare PIN