Provider Demographics
NPI:1801879911
Name:GUPTA, PRAG (MD)
Entity type:Individual
Prefix:DR
First Name:PRAG
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 3246
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-3246
Mailing Address - Country:US
Mailing Address - Phone:704-951-8444
Mailing Address - Fax:704-360-9978
Practice Address - Street 1:1585 FORNEY CREEK PKWY STE 2200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-9522
Practice Address - Country:US
Practice Address - Phone:704-951-8444
Practice Address - Fax:704-360-9978
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401220207RC0200X, 207RP1001X, 207RP1001X
VA0101246105207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
118315Medicare UPIN
NC2033589Medicare PIN