Provider Demographics
NPI:1508837949
Name:GUPTA, LOPA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:LOPA
Middle Name:Y
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 1:1230 MAMARONECK AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5207
Mailing Address - Country:US
Mailing Address - Phone:914-997-2646
Mailing Address - Fax:
Practice Address - Street 1:1230 MAMARONECK AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5207
Practice Address - Country:US
Practice Address - Phone:914-997-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200580174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01623101Medicaid
NY01623101Medicaid
NYF95956Medicare UPIN