Provider Demographics
NPI:1558616367
Name:GUPTA, KAVERI (MD, FRCPC)
Entity type:Individual
Prefix:DR
First Name:KAVERI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD, FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3569 8TH LINE ROAD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:K0C 2K0
Mailing Address - Country:CA
Mailing Address - Phone:613-821-4704
Mailing Address - Fax:613-482-5110
Practice Address - Street 1:3569 8TH LINE ROAD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:ONTARIO
Practice Address - Zip Code:K0C 2K0
Practice Address - Country:CA
Practice Address - Phone:613-821-4704
Practice Address - Fax:613-482-5110
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0531174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist