Provider Demographics
NPI:1437480548
Name:SURESH K GUPTA M.D. P.A.
Entity Type:Organization
Organization Name:SURESH K GUPTA M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-681-5922
Mailing Address - Street 1:9801 GEORGIA AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5276
Mailing Address - Country:US
Mailing Address - Phone:301-681-5922
Mailing Address - Fax:301-681-6463
Practice Address - Street 1:9801 GEORGIA AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-681-5922
Practice Address - Fax:301-681-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD32332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD431431001OtherMARYLAND MEDICAID
MDGU419081OtherHIGHMARK MEDICARE SERVICES