Provider Demographics
NPI:1942654207
Name:GUPTA, SHRUTI (DO)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 POYDRAS ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70163-1101
Mailing Address - Country:US
Mailing Address - Phone:504-527-9953
Mailing Address - Fax:504-527-9950
Practice Address - Street 1:4200 HOUMA BLVD FL 6
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2970
Practice Address - Country:US
Practice Address - Phone:504-503-4334
Practice Address - Fax:504-503-4341
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0062777207Q00000X, 208M00000X
LA307423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist