Provider Demographics
NPI:1710139605
Name:GUPTA, RACHNA (DPM)
Entity Type:Individual
Prefix:
First Name:RACHNA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:RACHNA
Other - Middle Name:
Other - Last Name:TANDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 21489
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-0489
Mailing Address - Country:US
Mailing Address - Phone:309-826-3774
Mailing Address - Fax:
Practice Address - Street 1:635 ALEXIAN WAY
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-1958
Practice Address - Country:US
Practice Address - Phone:423-886-0338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN691213ES0103X, 213E00000X
GAPOD001041213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3353754Medicaid
TN6550510001Medicare NSC
TN3350017Medicare PIN