Provider Demographics
NPI:1740284249
Name:GUPTA, SMITA (MD)
Entity type:Individual
Prefix:
First Name:SMITA
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 1:50 E HAMILTON AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0273
Mailing Address - Country:US
Mailing Address - Phone:408-227-2646
Mailing Address - Fax:408-227-2663
Practice Address - Street 1:50 E HAMILTON AVE STE 280
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0273
Practice Address - Country:US
Practice Address - Phone:408-227-2646
Practice Address - Fax:408-227-2663
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC134136207R00000X, 207RE0101X
PAMD424951207R00000X
IL036-118207RE0101X
IN01069530A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201021470Medicaid
IN000000715918OtherANTHEM
IL036118898Medicaid
ILP00478877OtherRR MDCR
INP01018467OtherRR MEDICARE
ILK41153Medicare PIN
IL256510Medicare PIN
IN201021470Medicaid
INM400048992Medicare PIN