Provider Demographics
NPI:1811182272
Name:GUPTA, PURBA (MD)
Entity type:Individual
Prefix:DR
First Name:PURBA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PURBA
Other - Middle Name:
Other - Last Name:SEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 ELMWOOD AVENUE BOX 689
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5871
Mailing Address - Fax:585-273-1055
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0005
Practice Address - Country:US
Practice Address - Phone:585-275-5871
Practice Address - Fax:585-273-1055
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295785207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKR70OtherMEDICARE