1679751853 NPI number — NEELAM GUPTA M.D.

Table of content: WILLIAM HALL (NPI 1306309091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679751853 NPI number — NEELAM GUPTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
NEELAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOEL
Provider Other First Name:
NEELAM
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679751853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 660599
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75266-0599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 E OVERTON RD
Provider Second Line Business Practice Location Address:
BLUIT-FLOWERS HEALTH CENTER
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75216-5946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-266-4200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2008

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:  01063691A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: N1663 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 206836302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 206836301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8CA284 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".