Provider Demographics
NPI:1568440907
Name:GUPTA, NITYANAND (MD)
Entity Type:Individual
Prefix:DR
First Name:NITYANAND
Middle Name:
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 1:2816 VEACH RD
Mailing Address - Street 2:STE 306
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6295
Mailing Address - Country:US
Mailing Address - Phone:270-240-5696
Mailing Address - Fax:270-240-5694
Practice Address - Street 1:2816 VEACH RD
Practice Address - Street 2:STE 306
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6295
Practice Address - Country:US
Practice Address - Phone:270-240-5696
Practice Address - Fax:270-240-5697
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39797207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64064231Medicaid
KYH11116Medicare UPIN
KY64064231Medicaid