Provider Demographics
NPI:1568685022
Name:GUPTA, NEERAJ (MD)
Entity Type:Individual
Prefix:
First Name:NEERAJ
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 1:9380F FORESTWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:903-330-3277
Mailing Address - Fax:703-368-7257
Practice Address - Street 1:9380F FORESTWOOD LANE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:903-330-3277
Practice Address - Fax:703-368-7257
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0101046623207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010005221Medicaid
VA040000498Medicare ID - Type Unspecified
VA010005221Medicaid