Basic Information
| Provider Information | |||||||||
| NPI: | 1528391703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUPTA | ||||||||
| FirstName: | NAMITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | CLEVELAND CLINIC | ||||||||
| Address2: | 9500 EUCLID AVE | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403127140 | ||||||||
| FaxNumber: | 4403127142 | ||||||||
| Practice Location | |||||||||
| Address1: | CLEVELAND CLINIC | ||||||||
| Address2: | 9500 EUCLID AVE | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403127140 | ||||||||
| FaxNumber: | 4403127142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2009 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 01073799A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 01073799A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000878132 | 01 | IN | BCBS BMG FULTON ST | OTHER | 201227050 | 05 | IN | MEDICAID |