Provider Demographics
NPI:1275910200
Name:GARG, RUPEN
Entity Type:Individual
Prefix:
First Name:RUPEN
Middle Name:
Last Name:GARG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LAURA DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-8548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:707 HAMILTON ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-2407
Practice Address - Country:US
Practice Address - Phone:484-862-3159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT208398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine