Provider Demographics
NPI:1871572644
Name:GUPTA, PUNEET K (DO)
Entity type:Individual
Prefix:DR
First Name:PUNEET
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2295 N SUSQUEHANNA TRL STE A
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-8495
Mailing Address - Country:US
Mailing Address - Phone:717-812-0731
Mailing Address - Fax:
Practice Address - Street 1:2295 N SUSQUEHANNA TRL STE A
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-8495
Practice Address - Country:US
Practice Address - Phone:717-812-0731
Practice Address - Fax:717-812-9848
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010558L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018599550001Medicaid
PA050751QLGMedicare PIN
PAH47680Medicare UPIN