MEDICARE: DR. ANITA GUPTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	210860	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295712594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANITA GUPTA M.D.

Provider Business Mailing Address
First Line	:	111 CLOCKTOWER COMMONS
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509
Country	:	US
Telephone Number	:	845-279-5187
Fax Number	:	845-279-5168

Provider Business Practice Location Address
First Line	:	111 CLOCK TOWER COMMONS
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-4055
Country	:	US
Telephone Number	:	845-279-5187
Fax Number	:	845-279-5168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	08/09/2011

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