Provider Demographics
NPI:1629479639
Name:GUPTA PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:GUPTA PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABU
Authorized Official - Middle Name:V
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-421-4099
Mailing Address - Street 1:PO BOX 706346
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45270-6346
Mailing Address - Country:US
Mailing Address - Phone:513-421-4099
Mailing Address - Fax:513-347-2116
Practice Address - Street 1:3260 WESTBOURNE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-5107
Practice Address - Country:US
Practice Address - Phone:513-421-4099
Practice Address - Fax:513-347-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350665742084P0805X
KY298312084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty