Provider Demographics
NPI:1962479543
Name:RENUKA GUPTA MD PC
Entity Type:Organization
Organization Name:RENUKA GUPTA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENUKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-345-7885
Mailing Address - Street 1:7215 HANOVER PKWY
Mailing Address - Street 2:D
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2019
Mailing Address - Country:US
Mailing Address - Phone:301-345-7885
Mailing Address - Fax:301-345-7422
Practice Address - Street 1:7215 HANOVER PKWY
Practice Address - Street 2:D
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2019
Practice Address - Country:US
Practice Address - Phone:301-345-7885
Practice Address - Fax:301-345-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406646400Medicaid
MDC62496Medicare UPIN
G01868R01Medicare PIN