Provider Demographics
NPI:1811073802
Name:GUHA, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GUHA
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 1:4142 ELBERTSON ST
Mailing Address - Street 2:SUITE102
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1620
Mailing Address - Country:US
Mailing Address - Phone:718-505-1300
Mailing Address - Fax:718-505-1883
Practice Address - Street 1:4142 ELBERTSON ST
Practice Address - Street 2:SUITE102
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1620
Practice Address - Country:US
Practice Address - Phone:718-505-1300
Practice Address - Fax:718-505-1883
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY217513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02105360Medicaid
NY02105360Medicaid