Provider Demographics
NPI:1730143926
Name:GUPTA, RAMESH CHANDRA I (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:CHANDRA
Last Name:GUPTA
Suffix:I
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 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-681-9670
Mailing Address - Fax:901-685-9023
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-681-9670
Practice Address - Fax:901-685-9023
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000014398174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB04868Medicare UPIN