Provider Demographics
NPI:1164425526
Name:GUPTA, RAJIV (MD, MRCP(UK))
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD, MRCP(UK)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1415
Mailing Address - Country:US
Mailing Address - Phone:740-450-9200
Mailing Address - Fax:
Practice Address - Street 1:1066 BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1415
Practice Address - Country:US
Practice Address - Phone:740-450-9200
Practice Address - Fax:855-882-7967
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-4759-G208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2131044Medicaid