Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | MD033955L | PA |
NPI | 1043328891 |
---|---|
Provider Name | Ved P. Gupta |
First Address | Philadelphia, PA 19115-4963 |
Second Address | Philadelphia, PA 19115-4963 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00062349200001 | (05) | PA |
0061721000 | INDEPENDENCE BLUE CROSS (01) | PA |
152955 | HIGHMARK BLUE SHIELD (01) | PA |
5768 | AETNA (01) | PA |
C32061 | (02) |