MEDICARE: DR. RAJ 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	2084N0400X	Neurology Physician	A93854	CA
2	2084N0400X	Neurology Physician	L776265	MI

General Provider Information

NPI Number	:	1831126689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJ GUPTA M.D

Provider Business Mailing Address
First Line	:	200 JOSE FIGUERES AVE
Second Line	:	STE 200
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1586
Country	:	US
Telephone Number	:	408-347-1600
Fax Number	:	408-347-0600

Provider Business Practice Location Address
First Line	:	200 JOSE FIGUERES AVE
Second Line	:	STE 200
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1586
Country	:	US
Telephone Number	:	408-347-1600
Fax Number	:	408-347-0600

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	03/24/2016

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