Provider Demographics
NPI:1659691889
Name:GUPTA, MAMTA R (MD)
Entity Type:Individual
Prefix:
First Name:MAMTA
Middle Name:R
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11995 SINGLETREE LN STE 500
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5349
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:1535 JAMESTOWN DR
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5312
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
CA1487572085R0202X
AZ503582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology