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Organization

AMITABH GUPTA MD PA

Active
Other names
COASTAL ORTHOPEDIC MEDICINE, PAIN MANAGEMENT & REHAB
Organization subpart
No

Provider details

NPI number
Authorized official
AMITABH P GUPTA MD (PRESIDENT)
(727) 526-8000
Entity
Organization

Contact information

Practice address
5800 49TH ST N, SUITE S-205, ST PETERSBURG, FL 33709-2146
(727) 526-8000
(727) 521-2600
Mailing address
5800 49TH ST N, SUITE S-205, ST PETERSBURG, FL 33709-2146
(727) 526-8000
(727) 521-2600

Taxonomy

Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
ME85225
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
17034
BL CRS/BL SHLD PROVIDER #
FL
05
2744716
FL
01
2799066
GHI PROVIDER NO.
FL
01
299916
AVMED PROVIDER NO.
FL
01
304583
WELLCARE PROVIDER NO.
FL
01
79665328
AETNA PROVIDER NO.
FL
01
AS34873800001
CIGNA PROVIDER NO.
FL
Enumeration date
04/04/2006
Last updated
12/26/2008
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