MEDICARE: BHAWNA 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
1	207Q00000X	Family Medicine Physician	45710	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45710	OTHER	CT	CT STATE LICENSE

General Provider Information

NPI Number	:	1700885100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHAWNA GUPTA MD

Provider Business Mailing Address
First Line	:	9 WASHINGTON AVE
Second Line	:	STE # 2D
City	:	HAMDEN
State	:	CT
Zip	:	06518-3267
Country	:	US
Telephone Number	:	203-371-7177
Fax Number	:

Provider Business Practice Location Address
First Line	:	5520 PARK AVE
Second Line	:	STE. 206
City	:	TRUMBULL
State	:	CT
Zip	:	06611-3463
Country	:	US
Telephone Number	:	203-371-7177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	11/18/2014

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