Provider Demographics
NPI:1487979969
Name:NANDITA GUPTA MD, PLLC
Entity type:Organization
Organization Name:NANDITA GUPTA MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANDITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-861-9500
Mailing Address - Street 1:1919 NORTH LOOP W STE 395
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1364
Mailing Address - Country:US
Mailing Address - Phone:713-861-9500
Mailing Address - Fax:713-861-9501
Practice Address - Street 1:1919 NORTH LOOP W STE 395
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1364
Practice Address - Country:US
Practice Address - Phone:713-861-9500
Practice Address - Fax:713-861-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
TXM8691305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center