Provider Demographics
NPI:1063466795
Name:GUPTA, RAJNISH K (MD)
Entity Type:Individual
Prefix:
First Name:RAJNISH
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 COMMERCE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8348
Mailing Address - Country:US
Mailing Address - Phone:614-882-2397
Mailing Address - Fax:614-898-5999
Practice Address - Street 1:85 COMMERCE PARK DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8348
Practice Address - Country:US
Practice Address - Phone:614-882-2397
Practice Address - Fax:614-898-5999
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.063590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0202131Medicaid
OHGU2013302OtherMEDICARE FQHC PIN
OHG17873Medicare UPIN