Basic Information
| Provider Information | |||||||||
| NPI: | 1851741268 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GUPTA | ||||||||
| FirstName: | SAMEER | ||||||||
| MiddleName: | GORAV | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 ELM ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014434992 | ||||||||
| FaxNumber: | 4014377241 | ||||||||
| Practice Location | |||||||||
| Address1: | 593 EDDY STREET | ||||||||
| Address2: | APC 10 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014447959 | ||||||||
| FaxNumber: | 4014447144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2016 | ||||||||
| LastUpdateDate: | 09/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 268157 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207ND0101X | MD17955 | RI | Y | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery |
No ID Information.