Provider Demographics
NPI:1144285552
Name:GUPTA, ANURAG (MD)
Entity type:Individual
Prefix:DR
First Name:ANURAG
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 1:3245 S RAINBOW BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6217
Mailing Address - Country:US
Mailing Address - Phone:702-228-4900
Mailing Address - Fax:702-228-1177
Practice Address - Street 1:3245 S RAINBOW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6217
Practice Address - Country:US
Practice Address - Phone:702-228-4900
Practice Address - Fax:702-228-1177
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV125722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1144285552Medicaid
NV464885917OtherTAX ID
NV1144285552Medicaid
NV464885917OtherTAX ID