Provider Demographics
NPI:1659659407
Name:GUPTA, ASTHA (MBBS)
Entity Type:Individual
Prefix:
First Name:ASTHA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:MOSS 4TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-9670
Mailing Address - Fax:215-456-7154
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:MOSS 4TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-9670
Practice Address - Fax:215-456-7154
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD452158207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA449307D23Medicare PIN