Provider Demographics
NPI:1962495531
Name:GUPTA, NAVNEET (MD)
Entity Type:Individual
Prefix:
First Name:NAVNEET
Middle Name:
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 1:213 E BUTLER RD STE F1
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2172
Mailing Address - Country:US
Mailing Address - Phone:864-284-0470
Mailing Address - Fax:864-284-0471
Practice Address - Street 1:213 E BUTLER ROAD
Practice Address - Street 2:SUITE F1
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2172
Practice Address - Country:US
Practice Address - Phone:864-284-0470
Practice Address - Fax:864-284-0471
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41890208100000X
SC27306208100000X
TN041890208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC273064Medicaid
SC273064Medicaid
SCAA05887169Medicare PIN
SCI14249Medicare UPIN