Provider Demographics
NPI:1528007770
Name:GUPTA, PREETI (MD)
Entity Type:Individual
Prefix:MRS
First Name:PREETI
Middle Name:
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:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01613-1045
Mailing Address - Country:US
Mailing Address - Phone:978-939-2035
Mailing Address - Fax:978-939-2039
Practice Address - Street 1:14 RICE RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:MA
Practice Address - Zip Code:01468-1332
Practice Address - Country:US
Practice Address - Phone:978-939-2035
Practice Address - Fax:978-939-2039
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2228292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042477296OtherPRIVATE HEALTH CARE SYSTE
MA92962OtherFALLON COMMUNITY HEALTH C
MA2093511Medicaid
MA042477296OtherUNITED HEALTH CARE
MA0382315OtherCIGNA
MA2093511OtherHEALTHY START
MA40001OtherHEALTH NEW ENGLAND
MAAA55725OtherHARVARD PILGRIM HEALTH CA
MA0007041OtherNEIGHBORHOOD HEALTH PLAN
MA042477296OtherHEALTH CARE VALUE MANAGEM
MAJ28354OtherBLUE CROSS BLUE SHIELD
MA92962OtherFALLON COMMUNITY HEALTH C
MAA38016Medicare ID - Type Unspecified