Provider Demographics
NPI:1871768291
Name:GUPTA-SHAH, KAVITA (MD)
Entity type:Individual
Prefix:
First Name:KAVITA
Middle Name:
Last Name:GUPTA-SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAVITA
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:295 BUCK RD STE 106
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1748
Mailing Address - Country:US
Mailing Address - Phone:215-322-1919
Mailing Address - Fax:215-322-2875
Practice Address - Street 1:295 BUCK RD STE 106
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-1748
Practice Address - Country:US
Practice Address - Phone:215-322-1919
Practice Address - Fax:215-322-2875
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-26
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08390800208000000X
MA243302208000000X
PAMD448419208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics