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NPI Code Detail

MEDICARE: MANJU GUPTA MD

MEDICARE: MANJU GUPTA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080A0000XPediatric Adolescent Medicine Physician35044556OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093797318
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANJU GUPTA MD
Provider Business Mailing Address
First Line : 424 WARDS CORNER RD STE 200
Second Line :
City : LOVELAND
State : OH
Zip : 45140-6966
Country : US
Telephone Number : 513-707-4041
Fax Number : 513-576-1020
Provider Business Practice Location Address
First Line : 100 RIVER VALLEY BLVD
Second Line :
City : NEW RICHMOND
State : OH
Zip : 45157-8566
Country : US
Telephone Number : 513-553-3114
Fax Number : 513-553-1032
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2005
Last Update Date : 09/10/2020

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Directions to “ MANJU GUPTA MD” Practice Location

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