Healthcare Provider Details

I. General information

NPI: 1760485346
Provider Name (Legal Business Name): VINEET KUMAR GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST PEDIATRIC CRITICAL CARE SERVICES
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

7602 BRAELANDS DR
SUMMERFIELD NC
27358-9363
US

V. Phone/Fax

Practice location:
  • Phone: 419-262-7428
  • Fax:
Mailing address:
  • Phone: 419-262-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.084463
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number208000000X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: