Provider Demographics
NPI:1356350888
Name:GUPTA, VINOD K (MD)
Entity type:Individual
Prefix:
First Name:VINOD
Middle Name:K
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 1:1871 PENNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-5227
Mailing Address - Country:US
Mailing Address - Phone:609-637-9707
Mailing Address - Fax:609-538-8031
Practice Address - Street 1:1871 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-5227
Practice Address - Country:US
Practice Address - Phone:609-637-9707
Practice Address - Fax:609-538-8031
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA349272080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C55240Medicare UPIN