Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 152014 | MA |
NPI | 1003889601 |
---|---|
Provider Name | Dr. Brinda Trivedi Gupta |
First Address | Newton, MA 02462-1650 |
Second Address | Newton, MA 02462-1650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 21/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G50625 | (02) |