Provider Demographics
NPI:1891879979
Name:GUPTA, ARVIND KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ARVIND
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 SPICED WINE AVE
Mailing Address - Street 2:UNIT 1101
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-2993
Mailing Address - Country:US
Mailing Address - Phone:717-460-5003
Mailing Address - Fax:
Practice Address - Street 1:42 BELLA VISTA DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1879
Practice Address - Country:US
Practice Address - Phone:717-460-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070110L207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1540117OtherGATEWAY
PA413789OtherUPMC
PA101045411Medicaid
PA781185OtherHIGHMARK BLUE SHIELD
PA101045411Medicaid
PAP01186927Medicare PIN
PA1540117OtherGATEWAY
PA033823FLTMedicare PIN
PAP01186927Medicare PIN