Provider Demographics
NPI:1952585838
Name:GUPTA, INDU (MD, MPH, MAPA)
Entity Type:Individual
Prefix:DR
First Name:INDU
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD, MPH, MAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MONTGOMERY ST. ONONDAGA COUNTY HEALTH DEPARTMENT
Mailing Address - Street 2:JOHN H. MULROY CIVIC CENTER 9TH FLOOR
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-435-3155
Mailing Address - Fax:315-435-5720
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1301
Practice Address - Country:US
Practice Address - Phone:607-547-4625
Practice Address - Fax:607-547-3259
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186651-1207R00000X
CAC54706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01274611Medicaid
NYF02615Medicare UPIN
NYRB6867Medicare PIN
NY01274611Medicaid
NY51147JMedicare PIN