Provider Demographics
NPI:1134390461
Name:GUPTA, EKTA (MD)
Entity type:Individual
Prefix:
First Name:EKTA
Middle Name:
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 1:1365C CLIFTON RD NE
Mailing Address - Street 2:BLDG C, SUITE C 11004
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-7148
Mailing Address - Country:US
Mailing Address - Phone:404-778-4446
Mailing Address - Fax:
Practice Address - Street 1:1365C CLIFTON RD NE
Practice Address - Street 2:BLDG C, SUITE C 11004
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-7148
Practice Address - Country:US
Practice Address - Phone:404-778-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2340222085R0202X
NJ25MA086441002085R0202X
FLME1053272085R0202X
GA0629932085R0202X
NC2009-015252085R0202X
PAMD4339532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134390461OtherBLUE CHOICE HMO/PPO
9229455OtherATENA PPO
1134390461OtherAMERIGROUP PROVIDER, PEACHSTATE NO., WELLCARE PROVIDER
1596314OtherCIGNA HMO/PPO
31350051OtherUHC
6147458OtherAETNA HMO