Provider Demographics
NPI:1487642732
Name:GUPTA, SHUCHI (MD)
Entity Type:Individual
Prefix:
First Name:SHUCHI
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 1:54 MILLER ST
Mailing Address - Street 2:STE 300
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4725
Mailing Address - Country:US
Mailing Address - Phone:508-350-2350
Mailing Address - Fax:508-350-2318
Practice Address - Street 1:54 MILLER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4725
Practice Address - Country:US
Practice Address - Phone:617-481-3300
Practice Address - Fax:617-481-3305
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA159381OtherTAHP
MA0123790Medicaid
MA710876OtherHPHC
MAJ22618OtherBC/BS
MA159381OtherTAHP
MA0123790Medicaid