Provider Demographics
NPI:1538151378
Name:GUPTA, GEETA (MD)
Entity type:Individual
Prefix:
First Name:GEETA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20050 HARVARD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6816
Mailing Address - Country:US
Mailing Address - Phone:216-283-0750
Mailing Address - Fax:216-491-6374
Practice Address - Street 1:20050 HARVARD AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6816
Practice Address - Country:US
Practice Address - Phone:216-283-0750
Practice Address - Fax:216-491-6374
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH56323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110026091OtherRAILROAD MEDICARE
OH102762OtherKAISER
OHR56323OtherSUMMA CARE
OH000000135084OtherANTHEM (OH)
OH0690882Medicaid
OH000000135084OtherUNICARE
OH0628131Medicare PIN
OHD97910Medicare UPIN