Provider Demographics
NPI:1649700766
Name:GUPTA, SUMIT
Entity type:Individual
Prefix:
First Name:SUMIT
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1620 TREMONT ST
Mailing Address - Street 2:RADIOLOGY ADMINISTRATION
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120
Mailing Address - Country:US
Mailing Address - Phone:617-732-8098
Mailing Address - Fax:617-525-7333
Practice Address - Street 1:75 FRANCIS STREET
Practice Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-525-8322
Practice Address - Fax:617-582-6056
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2835102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology