Provider Demographics
NPI:1497755615
Name:GUPTA, ADITYA (MD)
Entity Type:Individual
Prefix:
First Name:ADITYA
Middle Name:
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 1:3330 N 2ND ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2369
Mailing Address - Country:US
Mailing Address - Phone:602-261-7830
Mailing Address - Fax:602-261-7835
Practice Address - Street 1:9700 N 91ST ST STE A200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5098
Practice Address - Country:US
Practice Address - Phone:480-614-2000
Practice Address - Fax:480-614-1751
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49819207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ042286Medicaid
IN201067130Medicaid
INM400070557Medicare PIN