Provider Demographics
NPI:1922177062
Name:GUPTA, SHANKER LAL (MD)
Entity type:Individual
Prefix:DR
First Name:SHANKER
Middle Name:LAL
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 1:101 SAINT HELENA AVE
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-4217
Mailing Address - Country:US
Mailing Address - Phone:410-282-0646
Mailing Address - Fax:410-859-8373
Practice Address - Street 1:101 SAINT HELENA AVE
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-4217
Practice Address - Country:US
Practice Address - Phone:410-282-0646
Practice Address - Fax:410-859-8373
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0017003208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0124077OtherAETNA
MD5211338440001OtherCIGNA
MDR2970001OtherBLUE CHOICE
MDR2970001OtherBC BS FEP
MD20894OtherMAMSI
MD3925OtherCAREFIRST BC BS
MD37124OtherCOVENTRY HEALTH CARE
MDR2970001OtherBC BS FEP
D70390Medicare UPIN