Provider Demographics
NPI:1487662003
Name:GUPTA, SUMIT KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMIT
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3506
Practice Address - Street 1:2325 W ARBORS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2663
Practice Address - Country:US
Practice Address - Phone:704-295-3500
Practice Address - Fax:704-295-3506
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISG075835207W00000X
NC2008-01681207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1502COtherBCBSNC
MI180G410170OtherBCBS GROUP
SC20096148OtherSELECT HEALTH OF SC
NC2687OtherEVOLUTIONS HEALTHCARE
NC5910409Medicaid
NC7719573OtherAETNA
SCN01682Medicaid
MI104779114Medicaid
SC89695OtherCHCARES OF SC
SC01224936OtherAMERIGROUP
SCP00667584OtherMEDICARE RAILROAD
MISG075835OtherMED LICENSE
SC000000291982OtherUNISON HEALTH PLAN OF SC
SC773424OtherWELLCARE
MI0M78860005Medicare PIN
NC1502COtherBCBSNC
SCP00667584OtherMEDICARE RAILROAD
SC89695OtherCHCARES OF SC
I15032Medicare UPIN