Provider Demographics
NPI:1669968657
Name:GUPTA, RINA MODHA (MD)
Entity type:Individual
Prefix:
First Name:RINA
Middle Name:MODHA
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RINA
Other - Middle Name:BHARAT
Other - Last Name:MODHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-301-2092
Practice Address - Street 1:6 SHACKLEFORD DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2858
Practice Address - Country:US
Practice Address - Phone:501-500-5001
Practice Address - Fax:501-500-5008
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA292371207RR0500X
ART2024-195207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology