MEDICARE: DR. MONIKA GUPTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	C10008120	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	205465821	OTHER	DE	BLUE CROSS BLUE SHIELD OF DELAWARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073622072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONIKA GUPTA M.D.

Provider Business Mailing Address
First Line	:	314 E MAIN ST
Second Line	:	404 KELWAY PLAZA
City	:	NEWARK
State	:	DE
Zip	:	19711-7128
Country	:	US
Telephone Number	:	302-737-6041
Fax Number	:	302-737-5598

Provider Business Practice Location Address
First Line	:	314 E MAIN ST
Second Line	:	404 KELWAY PLAZA
City	:	NEWARK
State	:	DE
Zip	:	19711-7128
Country	:	US
Telephone Number	:	302-737-6041
Fax Number	:	302-737-5598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/12/2013

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