1306973136 NPI number — MOHINDER K. GUPTA, M.D., INC.

Table of content: (NPI 1306973136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306973136 NPI number — MOHINDER K. GUPTA, M.D., INC.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1306973136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 SUGARBUSH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44805-9737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-289-6466
Provider Business Mailing Address Fax Number:
419-281-4067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 SUGARBUSH CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44805-9737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-289-6466
Provider Business Practice Location Address Fax Number:
419-281-4067
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUPTA
Authorized Official First Name:
MOHINDER
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
419-289-6466

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  35041004 , 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: 0460513 . This is a "MEDICAID GROUP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2059561 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2322025 . This is a "MEDICAID GROUP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2682726 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0343711 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: MO9287132 . This is a "GROUP MEDICARE PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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