Healthcare Provider Details

I. General information

NPI: 1124402961
Provider Name (Legal Business Name): MEDHAVI GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COLUMBIAN ST
WEYMOUTH MA
02190-1601
US

IV. Provider business mailing address

101 COLUMBIAN ST
WEYMOUTH MA
02190-1601
US

V. Phone/Fax

Practice location:
  • Phone: 781-624-5000
  • Fax: 781-624-4840
Mailing address:
  • Phone: 781-624-5000
  • Fax: 781-624-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number287696
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD17519
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number287696
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: