MEDICARE: DR. RAKESH 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	207RP1001X	Pulmonary Disease Physician	10198	RI
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	256608	MA
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	10198	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639120561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAKESH GUPTA M.D.

Provider Business Mailing Address
First Line	:	67 GAR HWY
Second Line	:	PRIMACARE SLEEP CENTER
City	:	SOMERSET
State	:	MA
Zip	:	02726-1220
Country	:	US
Telephone Number	:	508-675-7090
Fax Number	:	508-675-7053

Provider Business Practice Location Address
First Line	:	67 GAR HWY
Second Line	:	PRIMACARE SLEEP CENTER
City	:	SOMERSET
State	:	MA
Zip	:	02726-1220
Country	:	US
Telephone Number	:	508-675-7090
Fax Number	:	508-675-7053

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	09/25/2013

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