1679737191 NPI number — DR. ABHA RANI GUPTA MD

Table of content: DR. ABHA RANI GUPTA MD (NPI 1679737191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679737191 NPI number — DR. ABHA RANI GUPTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
ABHA
Provider Middle Name:
RANI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1679737191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 S FRONTAGE RD
Provider Second Line Business Mailing Address:
PO BOX 207900
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06519-1124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-785-6066
Provider Business Mailing Address Fax Number:
203-785-7560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 S FRONTAGE RD
Provider Second Line Business Practice Location Address:
CHILD STUDY CENTER
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06519-1124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-785-6066
Provider Business Practice Location Address Fax Number:
203-785-7560
Provider Enumeration Date:
07/14/2008

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: 2080P0006X , with the licence number:  043557 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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