Provider Demographics
NPI:1912972803
Name:GUPTA, MUKUND (MD)
Entity Type:Individual
Prefix:
First Name:MUKUND
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:585-597 MERRIMACK STREET
Mailing Address - Street 2:LOWELL COMMUNITY HEALTH CENTER
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854
Mailing Address - Country:US
Mailing Address - Phone:978-746-7778
Mailing Address - Fax:978-970-0359
Practice Address - Street 1:585 MERRIMACK ST
Practice Address - Street 2:LOWELL COMMUNITY HEALTH CENTER
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854
Practice Address - Country:US
Practice Address - Phone:978-746-7778
Practice Address - Fax:978-970-0359
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0406187OtherUNITED HEALTH CARE
7371250OtherCIGNA
MA1305557Medicaid
042881348OtherUNICARE
80239OtherTUFTS
J14999OtherBLUE CROSS BLUE SHIELD
32169OtherFALLON
979891OtherNETWORK HEALTH
MAJ1499901OtherMEDICARE PTAN
0004089OtherNEIGHBORHOOD HEALTH PLAN
042881348OtherCHOICECARE
042881348OtherONE HEALTH
042881348OtherBEECH STREET
3485834OtherAETNA
692904OtherHARVARD PILGRIM HEALTHCAR
MAJ14999Medicare ID - Type Unspecified
J14999OtherBLUE CROSS BLUE SHIELD