Provider Demographics
NPI:1609929371
Name:GUPTA, PANKAJ CHAND (MD)
Entity Type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:CHAND
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5890 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1547
Mailing Address - Country:US
Mailing Address - Phone:330-305-2200
Mailing Address - Fax:330-305-2210
Practice Address - Street 1:5890 MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1547
Practice Address - Country:US
Practice Address - Phone:330-305-2200
Practice Address - Fax:330-305-2210
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227967207W00000X
OH35-099606207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0069769Medicaid
OHP01168884OtherMEDICARE RAILROAD
OHP01168884OtherMEDICARE RAILROAD