Healthcare Provider Details

I. General information

NPI: 1932367828
Provider Name (Legal Business Name): BHUSHAN C GUPTA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HART ST BLDG D
NEW BRITAIN CT
06052-1743
US

IV. Provider business mailing address

40 HART ST BLDG D
NEW BRITAIN CT
06052-1743
US

V. Phone/Fax

Practice location:
  • Phone: 860-229-5477
  • Fax:
Mailing address:
  • Phone: 860-229-5477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number019514
License Number StateCT

VIII. Authorized Official

Name: DR. BHUSHAN CHANDER GUPTA
Title or Position: PHYSICIAN MEMBER
Credential: M.D.
Phone: 860-229-5477