Provider Demographics
NPI:1154355600
Name:GUPTA, NARENDRA K (MD)
Entity type:Individual
Prefix:DR
First Name:NARENDRA
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10160 MEDLOCK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4419
Mailing Address - Country:US
Mailing Address - Phone:770-495-0011
Mailing Address - Fax:770-495-0012
Practice Address - Street 1:10160 MEDLOCK BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:770-495-0011
Practice Address - Fax:770-495-0012
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51657207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF65282Medicare UPIN
GA11SCDNWMedicare ID - Type Unspecified