Provider Demographics
NPI:1760815393
Name:GUPTA, GAURAV KUMAR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:601 ELMWOOD AVENUE
Mailing Address - Street 2:UNIVERSITY OF ROCHESTER MEDICAL CENTER, BOX 626
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:203-688-4242
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVENUE
Practice Address - Street 2:UNIVERSITY OF ROCHESTER MEDICAL CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:203-688-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA255725207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology