Provider Demographics
NPI:1659686970
Name:GUPTA, PRASAD D (MD)
Entity Type:Individual
Prefix:
First Name:PRASAD
Middle Name:D
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:145 HOSPITAL AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1462
Mailing Address - Country:US
Mailing Address - Phone:814-375-3722
Mailing Address - Fax:814-375-3363
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-375-3722
Practice Address - Fax:814-375-3363
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD430021207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease