Provider Demographics
NPI:1245331057
Name:GUPTA, URMIL R (MD)
Entity type:Individual
Prefix:
First Name:URMIL
Middle Name:R
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 1:340 ROUTE 202
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-3237
Mailing Address - Country:US
Mailing Address - Phone:914-617-8402
Mailing Address - Fax:914-617-8406
Practice Address - Street 1:340 ROUTE 202
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3237
Practice Address - Country:US
Practice Address - Phone:914-617-8402
Practice Address - Fax:914-617-8406
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1458381207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0027463OtherAETNA
0027463OtherUNITED HEALTH CARE
NY00764672Medicaid
CIM1458389OtherWORKMENS COMP
11000861OtherPALMETTO GBA
42583OtherCIGNA
94A871OtherBCBS
117024OtherMVP
SP004OtherOXFORD
0060341OtherGHI
SP004OtherOXFORD
117024OtherMVP