Provider Demographics
NPI:1710099064
Name:GUPTA, NUPUR (MD, MPH)
Entity Type:Individual
Prefix:
First Name:NUPUR
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:YAWKEY 6 D
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-643-1201
Mailing Address - Fax:617-726-0581
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAWKEY 6 D
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-643-1201
Practice Address - Fax:617-726-0581
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152951207RA0000X, 208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3192555Medicaid
G90872Medicare UPIN
MA3192555Medicaid