Provider Demographics
NPI:1508899139
Name:GUPTA, MAHENDRA K (MD)
Entity Type:Individual
Prefix:
First Name:MAHENDRA
Middle Name:K
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9224207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2408951OtherAMERICA'S PPO/ARAZ #
NDDA9011040085OtherPREFERRED ONE #
ND12157Medicaid
ND682610500Medicaid
ND3600619OtherMEDICA #
ND042H1GUOtherMNBS #
ND26356OtherNDBS #
ND3600620OtherMEDICA #
NDHP59530OtherHEALTHPARTNERS #
ND12157Medicaid
NDDA9011040085OtherPREFERRED ONE #
ND042H1GUOtherMNBS #