Individual
ATUL GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
40 CLWYD RD, BALA CYNWYD, PA 19004-2440
(215) 421-8876
Mailing address
40 CLWYD RD, BALA CYNWYD, PA 19004-2440
(215) 421-8876
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD067240L
PA
2085R0204X
Vascular & Interventional Radiology Physician
MD067240L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018138110006
—
PA
01
—
0181381102
AMERICHOICE
PA
01
—
0367630000
KEYSTONE HEALTHPLAN EAST
PA
01
—
3884840
AETNA
PA
01
—
597429
BLUE SHIELD PA
PA
Enumeration date
10/26/2006
Last updated
01/04/2016
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