Healthcare Provider Details

I. General information

NPI: 1659776243
Provider Name (Legal Business Name): NEHA GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EVERETT DR # 8305
OKLAHOMA CITY OK
73104-5047
US

IV. Provider business mailing address

1200 EVERETT DR # 8305
OKLAHOMA CITY OK
73104-5047
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5211
  • Fax: 405-271-2945
Mailing address:
  • Phone: 405-271-5211
  • Fax: 405-271-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35254
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number34405
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: