Provider Demographics
NPI:1598763856
Name:GUPTA, BABU V (MD)
Entity Type:Individual
Prefix:
First Name:BABU
Middle Name:V
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-0965
Mailing Address - Country:US
Mailing Address - Phone:513-563-0488
Mailing Address - Fax:
Practice Address - Street 1:4015 EXECUTIVE PARK DR STE 320
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-4015
Practice Address - Country:US
Practice Address - Phone:513-563-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY298312084P0800X
OH350665742084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64006372Medicaid
OH0983299Medicaid
F87072Medicare UPIN
KY1912801Medicare PIN
OH0983299Medicaid
OH260042327Medicare PIN