Healthcare Provider Details

I. General information

NPI: 1922014422
Provider Name (Legal Business Name): RAJAN GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELLIOT WAY
MANCHESTER NH
03103-3599
US

IV. Provider business mailing address

4 ELLIOT WAY STE 201
MANCHESTER NH
03103-3553
US

V. Phone/Fax

Practice location:
  • Phone: 603-627-1102
  • Fax:
Mailing address:
  • Phone: 603-663-3838
  • Fax: 603-663-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12787
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number12787
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number12787
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: