Healthcare Provider Details

I. General information

NPI: 1326411232
Provider Name (Legal Business Name): KSHITIJ GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SALEM ST STE 2
WILMINGTON MA
01887-1200
US

IV. Provider business mailing address

PO BOX 24532
NEW YORK NY
10087-4532
US

V. Phone/Fax

Practice location:
  • Phone: 978-664-1990
  • Fax:
Mailing address:
  • Phone: 781-744-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberE10045
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number1020920
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: