Healthcare Provider Details

I. General information

NPI: 1225894140
Provider Name (Legal Business Name): PUSHPAK GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: VEER PUSHPAK GUPTA MD

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 SALTERNS POINT 36 SALTERNS WAY
POOLE DORSET
BH148LW
GB

IV. Provider business mailing address

58 SALTERNS POINT 36 SALTERNS WAY
POOLE DORSET
BH148LW
GB

V. Phone/Fax

Practice location:
  • Phone: 513-764-9627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7551475
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: