Basic Information
Provider Information
NPI: 1164717716
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUPTA
FirstName: SEEMA
MiddleName: ANJALI
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 845347
Address2:  
City: DALLAS
State: TX
PostalCode: 752845347
CountryCode: US
TelephoneNumber: 2146450624
FaxNumber: 2146450078
Practice Location
Address1: 1935 MEDICAL DISTRICT DR
Address2:  
City: DALLAS
State: TX
PostalCode: 752357701
CountryCode: US
TelephoneNumber: 2144568899
FaxNumber: 2144565986
Other Information
ProviderEnumerationDate: 06/12/2011
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0804XQ1158TXN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
2084P0800XQ1158TXY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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