Provider Demographics
NPI:1225894140
Name:GUPTA, PUSHPAK (MD)
Entity Type:Individual
Prefix:DR
First Name:PUSHPAK
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VEER
Other - Middle Name:PUSHPAK
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:58 SALTERNS POINT
Mailing Address - Street 2:36 SALTERNS WAY
Mailing Address - City:POOLE
Mailing Address - State:DORSET
Mailing Address - Zip Code:BH148LW
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:58 SALTERNS POINT
Practice Address - Street 2:36 SALTERNS WAY
Practice Address - City:POOLE
Practice Address - State:DORSET
Practice Address - Zip Code:BH148LW
Practice Address - Country:GB
Practice Address - Phone:513-764-9627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ7551475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine