Provider Demographics
NPI:1790803294
Name:ALICJA GUPTA MDPC
Entity Type:Organization
Organization Name:ALICJA GUPTA MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICJA
Authorized Official - Middle Name:U
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-773-2709
Mailing Address - Street 1:21 MAYOR THOMAS J MCGRATH HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5351
Mailing Address - Country:US
Mailing Address - Phone:617-773-2709
Mailing Address - Fax:617-479-4642
Practice Address - Street 1:21 MAYOR THOMAS J MCGRATH HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5351
Practice Address - Country:US
Practice Address - Phone:617-773-2709
Practice Address - Fax:617-479-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1295731032OtherINDIVIDUAL NPI
MA9715291Medicaid
MA2027879Medicaid
MA2027879Medicaid
MA9715291Medicaid