Provider Demographics
NPI:1518914936
Name:GUPTA, NARESH C (MD)
Entity Type:Individual
Prefix:DR
First Name:NARESH
Middle Name:C
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 1:11007 SHALOM LN
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-4041
Mailing Address - Country:US
Mailing Address - Phone:301-733-4690
Mailing Address - Fax:
Practice Address - Street 1:11236 ROBINWOOD DR
Practice Address - Street 2:STE 106
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6800
Practice Address - Country:US
Practice Address - Phone:301-797-4092
Practice Address - Fax:301-797-4093
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059541174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409717300Medicaid
MDE28769Medicare UPIN