Provider Demographics
NPI:1427030212
Name:GUPTA, ATUL MOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ATUL
Middle Name:MOHAN
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1694 OLD TOWNE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5045
Mailing Address - Country:US
Mailing Address - Phone:843-571-3100
Mailing Address - Fax:843-766-7798
Practice Address - Street 1:55A SHERIDAN PARK CIR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6025
Practice Address - Country:US
Practice Address - Phone:843-836-5111
Practice Address - Fax:843-836-5112
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23765207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH88050Medicare UPIN