Provider Demographics
NPI:1528391703
Name:GUPTA, NAMITA (MD)
Entity Type:Individual
Prefix:DR
First Name:NAMITA
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:CLEVELAND CLINIC
Mailing Address - Street 2:9500 EUCLID AVE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:440-312-7140
Mailing Address - Fax:440-312-7142
Practice Address - Street 1:CLEVELAND CLINIC
Practice Address - Street 2:9500 EUCLID AVE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:440-312-7140
Practice Address - Fax:440-312-7142
Is Sole Proprietor?:No
Enumeration Date:2009-09-06
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01073799A207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000878132OtherBCBS BMG FULTON ST
IN201227050Medicaid
IN201227050Medicaid