Provider Demographics
NPI:1174954960
Name:GUPTA, SUSHIL (MD)
Entity type:Individual
Prefix:DR
First Name:SUSHIL
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE#504
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5238
Mailing Address - Country:US
Mailing Address - Phone:203-772-2499
Mailing Address - Fax:203-785-8818
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE#504
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-772-2499
Practice Address - Fax:203-785-8818
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT36095207RP1001X
CT036095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine