Provider Demographics
NPI:1811009236
Name:GHANSHYAM GUPTA, M.D. PC
Entity Type:Organization
Organization Name:GHANSHYAM GUPTA, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH CARE PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHANSHYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-838-4224
Mailing Address - Street 1:PO BOX 60410
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20859-0410
Mailing Address - Country:US
Mailing Address - Phone:301-838-4224
Mailing Address - Fax:301-838-4244
Practice Address - Street 1:10110 MOLECULAR DR
Practice Address - Street 2:SUITE 111
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7539
Practice Address - Country:US
Practice Address - Phone:301-838-4224
Practice Address - Fax:301-838-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty