Provider Demographics
NPI:1265426845
Name:GUPTA, RAJAT (MD)
Entity type:Individual
Prefix:
First Name:RAJAT
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 1:9998 CROSSPOINT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:9998 CROSSPOINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3307
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2130
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056645A2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00387639OtherRR MEDICARE PINS
IN000000342004OtherANTHEM
IN200499280Medicaid
INP00147569OtherRAILROAD MEDICARE
INP00177625OtherRR MEDICARE PINS
INP00364623OtherRR MEDICARE PINS
IN150900AAMedicare PIN
INP00177625OtherRR MEDICARE PINS
INI20280Medicare UPIN
IN200499280Medicaid
IN152380OOMedicare PIN
INP00364623OtherRR MEDICARE PINS
IN160120GGMedicare PIN
IN822400HHMedicare PIN
INP00387639OtherRR MEDICARE PINS
IN152520MMMedicare PIN
IN152690DDMedicare PIN
IN222750GGMedicare PIN
IN151720GGMedicare PIN
IN151700XXMedicare PIN
IN15156011Medicare PIN