Provider Demographics
NPI:1336373133
Name:GUPTA, NISHI (MD)
Entity Type:Individual
Prefix:
First Name:NISHI
Middle Name:
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 1:1111 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3476
Mailing Address - Country:US
Mailing Address - Phone:281-587-5078
Mailing Address - Fax:281-465-4596
Practice Address - Street 1:1111 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 250
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3476
Practice Address - Country:US
Practice Address - Phone:281-587-5078
Practice Address - Fax:281-465-4596
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8359207R00000X
LA205485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2305654Medicaid
LA2305654Medicaid
LAP01161336Medicare PIN