Provider Demographics
NPI:1518991892
Name:GUPTA, AMBRISH K (MD)
Entity Type:Individual
Prefix:
First Name:AMBRISH
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:611 S CARLIN SPRINGS RD STE 504
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1088
Mailing Address - Country:US
Mailing Address - Phone:703-998-6666
Mailing Address - Fax:703-578-0700
Practice Address - Street 1:611 S CARLIN SPRINGS RD STE 504
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1088
Practice Address - Country:US
Practice Address - Phone:703-998-6666
Practice Address - Fax:703-578-0700
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035666207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC61917Medicare UPIN