Provider Demographics
NPI:1376572842
Name:GUPTA, MALA R (MD)
Entity Type:Individual
Prefix:DR
First Name:MALA
Middle Name:R
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278980
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 S CLINTON AVE
Practice Address - Street 2:BLDG G-2
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2668
Practice Address - Country:US
Practice Address - Phone:585-341-7683
Practice Address - Fax:585-341-4220
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY161876207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE22771Medicare UPIN
NYRA6833Medicare PIN