=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194914804
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REMA ANEJA GUPTA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2007
-----------------------------------------------------
Last Update Date | 01/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11616 LAKE UNDERHILL RD STE 205
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32825-4466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-601-5309
-----------------------------------------------------
Fax | 407-482-8698
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11616 LAKE UNDERHILL RD STE 215
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32825-4465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-482-7788
-----------------------------------------------------
Fax | 407-482-8698
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 036-115553
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 87666
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | ME105761
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------