Provider Demographics
NPI:1457332868
Name:GUPTA, ANITA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
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 1:3300 W LAKE MARY BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3570
Mailing Address - Country:US
Mailing Address - Phone:407-321-7111
Mailing Address - Fax:407-321-7446
Practice Address - Street 1:3300 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3570
Practice Address - Country:US
Practice Address - Phone:407-321-7111
Practice Address - Fax:407-321-7446
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43446Medicare ID - Type Unspecified
F39644Medicare UPIN