Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 229884 | MA |
N | 208000000X | Pediatrician | MD421816 | PA |
Y | 2080P0205X | Pediatric Endocrinologist | 229884 | MA |
N | 2080P0205X | Pediatric Endocrinologist | MD421816 | PA |
NPI | 1386673267 |
---|---|
Provider Name | Olga Theresa Gupta |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 06/04/2012 |