Provider Demographics
NPI:1407367741
Name:CONGENIAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CONGENIAL HEALTHCARE, LLC
Other - Org Name:BHAGWAN GUPTA, MD, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAGWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-599-0594
Mailing Address - Street 1:3 POST OFFICE SQ
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-2218
Mailing Address - Country:US
Mailing Address - Phone:781-599-0594
Mailing Address - Fax:
Practice Address - Street 1:3 POST OFFICE SQ
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2218
Practice Address - Country:US
Practice Address - Phone:781-599-0594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONGENIAL HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty