Provider Demographics
NPI:1942543418
Name:GUPTA, MANEESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MANEESH
Middle Name:
Last Name:GUPTA
Suffix:
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 1:407-33 LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M5C3H8
Mailing Address - Country:CA
Mailing Address - Phone:416-904-8000
Mailing Address - Fax:
Practice Address - Street 1:407-33 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:ONTARIO
Practice Address - Zip Code:M5C3H8
Practice Address - Country:CA
Practice Address - Phone:416-904-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361315322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology