Provider Demographics
NPI:1598721094
Name:GUPTA, SATISH P (MD)
Entity Type:Individual
Prefix:DR
First Name:SATISH
Middle Name:P
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 1:246 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01752
Mailing Address - Country:US
Mailing Address - Phone:508-787-3460
Mailing Address - Fax:508-357-4150
Practice Address - Street 1:246 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:508-787-3460
Practice Address - Fax:508-357-4150
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37947207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE56012OtherPIN NUMBER
MAB73973Medicare UPIN