Provider Demographics
NPI:1811011646
Name:GUPTA, MAYA (MD)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 STANTON CHRISTIANA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2146
Mailing Address - Country:US
Mailing Address - Phone:302-994-9692
Mailing Address - Fax:302-994-9803
Practice Address - Street 1:537 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2146
Practice Address - Country:US
Practice Address - Phone:302-994-9692
Practice Address - Fax:302-994-9803
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005134207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD765802800Medicaid
DE001059801Medicaid
DE001059801Medicaid
DE022000I60Medicare PIN
MD765802800Medicaid