1164429510 NPI number — MR. ALOK K GUPTA MD

Table of content: MR. ALOK K GUPTA MD (NPI 1164429510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164429510 NPI number — MR. ALOK K GUPTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
ALOK
Provider Middle Name:
K
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164429510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-248-6666
Provider Business Mailing Address Fax Number:
571-248-6667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7350 HERITAGE VILLAGE PLAZA
Provider Second Line Business Practice Location Address:
SUITE 101 ARJUN MEDICAL CENTER PC
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-248-6666
Provider Business Practice Location Address Fax Number:
571-248-6667
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101236189 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010082439 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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