Provider Demographics
NPI:1891809281
Name:GUPTA, ASHA K (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:K
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 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-933-9600
Mailing Address - Fax:954-781-9828
Practice Address - Street 1:3896 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6612
Practice Address - Country:US
Practice Address - Phone:954-933-9600
Practice Address - Fax:954-781-9828
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61061207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377162800Medicaid
FL377162800Medicaid
FLE49157Medicare UPIN