Provider Demographics
NPI:1952596900
Name:GUPTA, SHILPA (DO)
Entity type:Individual
Prefix:
First Name:SHILPA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WALTER REED BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-3701
Mailing Address - Country:US
Mailing Address - Phone:972-487-5462
Mailing Address - Fax:
Practice Address - Street 1:700 WALTER REED BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-3701
Practice Address - Country:US
Practice Address - Phone:972-487-5462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9960207R00000X
TXN6333207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2173932-01Medicaid
TXP00942634OtherRAILROAD MEDICARE NUMBER
TXP00942634OtherRAILROAD MEDICARE NUMBER
TXB156025Medicare PIN