1124095823 NPI number — MADHUKAR GUPTA M.D.

Table of content: MADHUKAR GUPTA M.D. (NPI 1124095823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124095823 NPI number — MADHUKAR GUPTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
MADHUKAR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124095823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4380 MALSBARY RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-5644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-366-4488
Provider Business Mailing Address Fax Number:
513-366-4480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11140 MONTGOMERY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45249-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-792-7800
Provider Business Practice Location Address Fax Number:
513-792-7807
Provider Enumeration Date:
03/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  35083146 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: 35083146 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000310785 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 283830 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2435805 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64088099 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1519679400 . This is a "WORKMANS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2503778 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200503740 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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