Healthcare Provider Details

I. General information

NPI: 1225414352
Provider Name (Legal Business Name): MONA R GUPTA, DO INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8304 CREEDMOOR RD
RALEIGH NC
27613-1697
US

IV. Provider business mailing address

3801 BARRETT DR
RALEIGH NC
27609-7224
US

V. Phone/Fax

Practice location:
  • Phone: 919-870-8409
  • Fax:
Mailing address:
  • Phone: 919-870-8409
  • Fax: 877-622-8953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MONA RAJ GUPTA
Title or Position: CEO / DO
Credential:
Phone: 919-870-8409