Healthcare Provider Details

I. General information

NPI: 1598721094
Provider Name (Legal Business Name): SATISH P GUPTA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 MAPLE ST
MARLBORO MA
01752
US

IV. Provider business mailing address

246 MAPLE ST
MARLBORO MA
01752
US

V. Phone/Fax

Practice location:
  • Phone: 508-787-3460
  • Fax: 508-357-4150
Mailing address:
  • Phone: 508-787-3460
  • Fax: 508-357-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number37947
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: