Provider Demographics
NPI:1467412924
Name:GUPTA, NIRMAL (DPM)
Entity Type:Individual
Prefix:
First Name:NIRMAL
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CORPORATE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2664
Mailing Address - Country:US
Mailing Address - Phone:610-258-1855
Mailing Address - Fax:610-258-1053
Practice Address - Street 1:21 CORPORATE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2664
Practice Address - Country:US
Practice Address - Phone:610-258-1855
Practice Address - Fax:610-258-1053
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002806R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT90360Medicare UPIN
GU585268Medicare ID - Type Unspecified