MEDICARE: AWADHESH K GUPTA MD

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	207R00000X	Internal Medicine Physician	021366	GA
2	207R00000X	Internal Medicine Physician	139718	NY
3	207R00000X	Internal Medicine Physician	20577	AL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851387971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AWADHESH K GUPTA MD

Provider Business Mailing Address
First Line	:	1440 N MCKENZIE ST
Second Line	:
City	:	FOLEY
State	:	AL
Zip	:	36535-2234
Country	:	US
Telephone Number	:	251-970-3400
Fax Number	:	251-970-3406

Provider Business Practice Location Address
First Line	:	1440 N MCKENZIE ST
Second Line	:
City	:	FOLEY
State	:	AL
Zip	:	36535-2234
Country	:	US
Telephone Number	:	251-970-3400
Fax Number	:	251-970-3406

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	05/27/2020

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Directions to “ AWADHESH K GUPTA MD” Practice Location

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