Provider Demographics
NPI:1750579017
Name:DR MONIKA GUPTA PA
Entity type:Organization
Organization Name:DR MONIKA GUPTA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-737-5074
Mailing Address - Street 1:314 E MAIN ST
Mailing Address - Street 2:404 KELWAY PLAZA
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7128
Mailing Address - Country:US
Mailing Address - Phone:302-737-5074
Mailing Address - Fax:302-737-5598
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:404 KELWAY PLAZA
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7128
Practice Address - Country:US
Practice Address - Phone:302-737-5074
Practice Address - Fax:302-737-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10008120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I67985Medicare UPIN
DE492160Medicare PIN