Provider Demographics
NPI:1457657090
Name:GANESH P GUPTA MDPA
Entity Type:Organization
Organization Name:GANESH P GUPTA MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GANESH
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-422-3576
Mailing Address - Street 1:PO BOX 975
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-0975
Mailing Address - Country:US
Mailing Address - Phone:281-422-3576
Mailing Address - Fax:281-422-0295
Practice Address - Street 1:1610 JAMES BOWIE DR STE A114
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-3383
Practice Address - Country:US
Practice Address - Phone:281-422-3576
Practice Address - Fax:281-422-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-30
Last Update Date:2011-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129715206Medicaid
TX129715206Medicaid
TX00159FMedicare PIN