Healthcare Provider Details

I. General information

NPI: 1548902489
Provider Name (Legal Business Name): ALEJANDRO JAVIER GUPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST
NEWTON MA
02462-1699
US

IV. Provider business mailing address

2014 WASHINGTON ST
NEWTON MA
02462-1699
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6467
  • Fax:
Mailing address:
  • Phone: 617-243-6467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number293875
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: