Provider Demographics
NPI:1295731032
Name:GUPTA, ALICJA U (MD)
Entity type:Individual
Prefix:DR
First Name:ALICJA
Middle Name:U
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:21 MCGRATH HWY
Mailing Address - Street 2:STE 202
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5351
Mailing Address - Country:US
Mailing Address - Phone:617-773-2709
Mailing Address - Fax:617-479-4642
Practice Address - Street 1:21 MCGRATH HWY
Practice Address - Street 2:STE 202
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5351
Practice Address - Country:US
Practice Address - Phone:617-773-2709
Practice Address - Fax:617-479-4642
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA76690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2027879Medicaid
MA9715291Medicaid
MAC15065Medicare ID - Type Unspecified
MA2027879Medicaid