Provider Demographics
NPI:1073001772
Name:GUPTA, MANISH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:KUMAR
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:DANBURY HOSPITAL
Mailing Address - Street 2:24 HOSPITAL AVE.
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6099
Mailing Address - Country:US
Mailing Address - Phone:203-739-8105
Mailing Address - Fax:203-739-9092
Practice Address - Street 1:DANBURY HOSPITAL, 24 HOSPITAL AVENUE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-739-8105
Practice Address - Fax:203-739-4912
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2022-05-07
Deactivation Date:2018-11-29
Deactivation Code:
Reactivation Date:2019-07-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program