Healthcare Provider Details

I. General information

NPI: 1689240715
Provider Name (Legal Business Name): GUNJAN GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HAZARD AVE STE 206
ENFIELD CT
06082-5447
US

IV. Provider business mailing address

1290 SILAS DEANE HWY
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-696-2240
  • Fax: 860-724-4405
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number52359
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: