Provider Demographics
NPI:1457344673
Name:GUPTA, NAVIN (MD)
Entity type:Individual
Prefix:
First Name:NAVIN
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 1:2101 N WALDRON ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1197
Mailing Address - Country:US
Mailing Address - Phone:620-669-2500
Mailing Address - Fax:877-395-6248
Practice Address - Street 1:2101 N WALDRON ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1197
Practice Address - Country:US
Practice Address - Phone:620-669-2500
Practice Address - Fax:877-395-6248
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS48652207RC0000X
VA0101245952207RC0000X, 207RI0011X
SD7291207RI0011X
TN25135207RI0011X
NE28827207RI0011X
OH35068659207RI0011X
IAMD-42931207RI0011X
GA55947207RI0011X
FL113118207RI0011X
IN01078008A207RI0011X
NC85010207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6005980Medicaid
OH000000584980OtherANTHEM BLUE CROSS BLUE SHIELD
TN3823389OtherMEDICARE
GA529060548AMedicaid
KS30005100690001Medicaid
TN3823389Medicaid
GA529060548AMedicaid
OH4248241Medicare PIN
GA529060548AMedicaid