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NPI Code Detail

MEDICARE: RINA MODHA GUPTA MD

MEDICARE:   RINA MODHA GUPTA  MD
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
1207RR0500XRheumatology Physician292371MA
2207RR0500XRheumatology PhysicianT2024-195AR

General Provider Information

NPI Number : 1669968657
Entity Type Code : Individual
Provider Name (Legal Business Name) : RINA MODHA GUPTA MD
Provider Business Mailing Address
First Line : PO BOX 497
Second Line :
City : AUGUSTA
State : AR
Zip : 72006-0497
Country : US
Telephone Number : 870-347-2534
Fax Number : 870-301-2092
Provider Business Practice Location Address
First Line : 6 SHACKLEFORD DR
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-2858
Country : US
Telephone Number : 501-500-5001
Fax Number : 501-500-5008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2018
Last Update Date : 08/12/2024

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