Provider Demographics
NPI:1821269630
Name:GUPTA, CHANDRA (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRA
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 1:4002 SPRINGBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4229
Mailing Address - Country:US
Mailing Address - Phone:908-412-0333
Mailing Address - Fax:908-412-8350
Practice Address - Street 1:156 ROSEVILLE AVENUE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107
Practice Address - Country:US
Practice Address - Phone:973-484-3848
Practice Address - Fax:973-484-5226
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03521700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C54752Medicare UPIN