MEDICARE: DR. SHANKER LAL 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
1	208600000X	Surgery Physician	D0017003	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0124077	OTHER	MD	AETNA
2	5211338440001	OTHER	MD	CIGNA
3	R2970001	OTHER	MD	BLUE CHOICE
4	R2970001	OTHER	MD	BC BS FEP
5	20894	OTHER	MD	MAMSI
6	3925	OTHER	MD	CAREFIRST BC BS
7	37124	OTHER	MD	COVENTRY HEALTH CARE

General Provider Information

NPI Number	:	1922177062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANKER LAL GUPTA MD

Provider Business Mailing Address
First Line	:	101 SAINT HELENA AVE
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-4217
Country	:	US
Telephone Number	:	410-282-0646
Fax Number	:	410-859-8373

Provider Business Practice Location Address
First Line	:	101 SAINT HELENA AVE
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-4217
Country	:	US
Telephone Number	:	410-282-0646
Fax Number	:	410-859-8373

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	12/27/2007

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Directions to “ DR. SHANKER LAL GUPTA MD” Practice Location

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