Basic Information
| Provider Information | |||||||||
| NPI: | 1699179283 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HINA T GUPTA MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 E SAMPLE RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330644443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547732383 | ||||||||
| FaxNumber: | 9547836845 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E SAMPLE RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330644443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547732383 | ||||||||
| FaxNumber: | 9547836845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2014 | ||||||||
| LastUpdateDate: | 10/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | GUPTA | ||||||||
| AuthorizedOfficialFirstName: | HINA | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3196218376 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | ME113564 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 007743000 | 05 | FL | MEDICAID |