Provider Demographics
NPI:1407899420
Name:GUPTA, AMITABHA (MD, FACS)
Entity Type:Individual
Prefix:
First Name:AMITABHA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:AMIT
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, FACS
Mailing Address - Street 1:3808-99 HARBOUR SQ.
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ON
Mailing Address - Zip Code:M5J 2H2
Mailing Address - Country:CA
Mailing Address - Phone:647-991-3277
Mailing Address - Fax:
Practice Address - Street 1:3808-99 HARBOUR SQ.
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:ON
Practice Address - Zip Code:M5J 2H2
Practice Address - Country:CA
Practice Address - Phone:647-991-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85190207W00000X, 207W00000X
PAMD057492L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G20865Medicare UPIN
PA0016703800005Medicaid