Provider Demographics
NPI:1437226651
Name:GUPTA, SHIVA (MD)
Entity type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ALFRED ST
Mailing Address - Street 2:STE 370
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1929
Mailing Address - Country:US
Mailing Address - Phone:847-719-2220
Mailing Address - Fax:847-719-2265
Practice Address - Street 1:7 ALFRED ST STE 370
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1929
Practice Address - Country:US
Practice Address - Phone:781-528-6720
Practice Address - Fax:781-528-6720
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257801207R00000X
IL036-102547207R00000X
IL036102547208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H37995Medicare UPIN
H37995Medicare UPIN