Healthcare Provider Details

I. General information

NPI: 1942466842
Provider Name (Legal Business Name): RICHA GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 BROAD AVE SUITE 500
GULFPORT MS
39501-8907
US

IV. Provider business mailing address

1110 BROAD AVE SUITE 500
GULFPORT MS
39501-8907
US

V. Phone/Fax

Practice location:
  • Phone: 228-575-2588
  • Fax: 228-864-4154
Mailing address:
  • Phone: 228-575-2588
  • Fax: 228-864-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2007006085
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number22001
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: