Provider Demographics
NPI:1659358836
Name:GUPTA, RAJEEV K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJEEV
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2138 MENDON RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864
Mailing Address - Country:US
Mailing Address - Phone:401-305-5515
Mailing Address - Fax:401-305-5518
Practice Address - Street 1:2138 MENDON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864
Practice Address - Country:US
Practice Address - Phone:401-305-5515
Practice Address - Fax:401-305-5518
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD08729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9021022Medicaid
RI119021022Medicare PIN