Basic Information
Provider Information
NPI: 1003007816
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUPTA
FirstName: ARUSHA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8630 FENTON ST
Address2: SUITE 514
City: SILVER SPRING
State: MD
PostalCode: 209103806
CountryCode: US
TelephoneNumber: 3015871220
FaxNumber:  
Practice Location
Address1: 8630 FENTON ST
Address2: SUITE 514
City: SILVER SPRING
State: MD
PostalCode: 209103806
CountryCode: US
TelephoneNumber: 3015871220
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/06/2007
LastUpdateDate: 11/29/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000XD70515MDY Allopathic & Osteopathic PhysiciansOphthalmology 
207W00000X245090NYN Allopathic & Osteopathic PhysiciansOphthalmology 

ID Information
IDTypeStateIssuerDescription
03298780005MD MEDICAID


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