Provider Demographics
NPI:1437121480
Name:GUPTA, ANJU (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJU
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 1:94 OLEAN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2596
Mailing Address - Country:US
Mailing Address - Phone:716-652-0237
Mailing Address - Fax:716-652-0983
Practice Address - Street 1:94 OLEAN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2596
Practice Address - Country:US
Practice Address - Phone:716-652-0237
Practice Address - Fax:716-652-0983
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3959208000000X
NY249587208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155019001Medicaid
NY03122245Medicaid