Individual
PRADEEP K GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1715 N GEORGE MASON DR, SUITE 204, ARLINGTON, VA 22205-3609
(703) 522-0751
(703) 528-4209
Mailing address
1914 GABLES LN, VIENNA, VA 22182-6008
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
0101044494
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101044494
STATE LICENSE
VA
Enumeration date
12/12/2006
Last updated
07/09/2012
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