Provider Demographics
NPI:1144262023
Name:GUPTA, MANISH (MD)
Entity type:Individual
Prefix:DR
First Name:MANISH
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:777 WALTER REED BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5727
Practice Address - Country:US
Practice Address - Phone:972-272-3417
Practice Address - Fax:972-487-1749
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4411207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154481901Medicaid
TX154481903Medicaid
TX154481904Medicaid
OK100845220AMedicaid
TX154481902Medicaid
TX8R1452OtherBLUE CROSS OF TEXAS
TX830008366Medicare PIN
TX154481902Medicaid
TX8A8556Medicare PIN
TX154481903Medicaid
TX154481901Medicaid
TX8327B7Medicare PIN