Healthcare Provider Details

I. General information

NPI: 1639120561
Provider Name (Legal Business Name): RAKESH GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 GAR HWY PRIMACARE SLEEP CENTER
SOMERSET MA
02726-1220
US

IV. Provider business mailing address

67 GAR HWY PRIMACARE SLEEP CENTER
SOMERSET MA
02726-1220
US

V. Phone/Fax

Practice location:
  • Phone: 508-675-7090
  • Fax: 508-675-7053
Mailing address:
  • Phone: 508-675-7090
  • Fax: 508-675-7053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number10198
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number256608
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number10198
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: