Provider Demographics
NPI:1548207970
Name:GASTROENTEROLOGY SPECIALTY GROUP, LLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY SPECIALTY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TARUN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-452-1411
Mailing Address - Street 1:115 TECHNOLOGY DR
Mailing Address - Street 2:STE B-106
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1395
Mailing Address - Country:US
Mailing Address - Phone:203-452-1411
Mailing Address - Fax:203-452-1412
Practice Address - Street 1:115 TECHNOLOGY DR
Practice Address - Street 2:STE B-106
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1395
Practice Address - Country:US
Practice Address - Phone:203-452-1411
Practice Address - Fax:203-452-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032684207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT032684OtherCONNECTICARE PROVIDER NUM
CTOV6284OtherHEALTHNET PROV. #
CT001326843Medicaid
CT010032684CT05OtherBC PROVIDER NUMBER
CT110239944OtherMEDICARE RAILROAD PROV. #
CT5373649OtherAETNA PROVIDER #
CTP653628OtherOXFORD PROVIDER NUMBER
CT2185309009OtherCIGNA PROV. #
CT88411OtherUS HEALTHCARE PROV. #
C03523Medicare PIN
CTP653628OtherOXFORD PROVIDER NUMBER