Active NPI
Praveen Kumar Gupta, M.D.
- Internal Medicine Physician
- Fairfax, VA
National Provider Identifier
1982965398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 010154944
- Practice address
- 4080 Chain Bridge Road
Fairfax, VA 22030 - Phone
- (703) 246-4949
- Fax
- (703) 352-0217
- NPI assigned
- Jun 1, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 010154944 | VA | Primary |
Addresses
Primary practice location
4080 Chain Bridge Road
Fairfax, VA 22030
Mailing address
4080 Chain Bridge Rd
Fairfax, VA 22030-4080
Phone (703) 246-4949
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010154944 | VA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338508800000",
"number": "1982965398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4080 CHAIN BRIDGE RD",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220304080",
"telephone_number": "703-246-4949",
"fax_number": "703-352-0217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4080 CHAIN BRIDGE ROAD",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "22030",
"telephone_number": "703-246-4949",
"fax_number": "703-352-0217"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUPTA",
"first_name": "PRAVEEN",
"middle_name": "KUMAR",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-01",
"last_updated": "2012-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "VA",
"license": "010154944",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.