Healthcare Provider Details

I. General information

NPI: 1750368239
Provider Name (Legal Business Name): RAJESH GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 WILLARD DAIRY RD STE 303
HIGH POINT NC
27265-8354
US

IV. Provider business mailing address

PO BOX 4485
ASHEBORO NC
27204-4485
US

V. Phone/Fax

Practice location:
  • Phone: 336-547-1745
  • Fax:
Mailing address:
  • Phone: 336-629-3313
  • Fax: 336-629-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number9700067
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: