Healthcare Provider Details

I. General information

NPI: 1982044459
Provider Name (Legal Business Name): AYUSH GUPTA MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVENUE CHILDRENS HOSPITAL OF NEW ORLEANS
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

1733 ROBERT ST
NEW ORLEANS LA
70115-4916
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9400
  • Fax:
Mailing address:
  • Phone: 646-267-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number312446
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberV4238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: