Healthcare Provider Details

I. General information

NPI: 1487944567
Provider Name (Legal Business Name): RITU GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 EXECUTIVE CENTER DR STE 100
LITTLE ROCK AR
72211-4386
US

IV. Provider business mailing address

PO BOX 56619
LITTLE ROCK AR
72215-6619
US

V. Phone/Fax

Practice location:
  • Phone: 501-604-2695
  • Fax: 501-604-2699
Mailing address:
  • Phone: 501-604-2695
  • Fax: 501-604-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberE-21208
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: