Provider Demographics
NPI:1295756054
Name:GUPTA, ARUN K (MD)
Entity type:Individual
Prefix:DR
First Name:ARUN
Middle Name:K
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 1:9306 FOREST POINT CIR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4700
Mailing Address - Country:US
Mailing Address - Phone:703-330-3322
Mailing Address - Fax:703-330-5051
Practice Address - Street 1:9306 FOREST POINT CIR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4700
Practice Address - Country:US
Practice Address - Phone:703-330-3322
Practice Address - Fax:703-330-5051
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005886961Medicaid
VA005886961Medicaid
VA00V607A37Medicare PIN