Provider Demographics
NPI:1740599331
Name:GUPTA, AMIT (MBBS; MD)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MBBS; MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8315
Mailing Address - Fax:614-293-6935
Practice Address - Street 1:395 W 12TH AVE RM 460
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-293-8315
Practice Address - Fax:614-293-6935
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2767202085R0202X
OH35.1223812085R0204X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology