Healthcare Provider Details

I. General information

NPI: 1821238676
Provider Name (Legal Business Name): GUNJAN GUPTA MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GUNJAN GUPTA M.D., PHD

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL AVE DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
DANBURY CT
06810-6099
US

IV. Provider business mailing address

24 HOSPITAL AVE DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
DANBURY CT
06810-6099
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-6471
  • Fax:
Mailing address:
  • Phone: 973-864-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number52359
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number52359
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: