Healthcare Provider Details

I. General information

NPI: 1609804038
Provider Name (Legal Business Name): ASHA GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SOMERDALE ROAD 120 ECHELON MEDICAL CENTER
VOORHEES NJ
08043
US

IV. Provider business mailing address

600 SOMERDALE ROAD 120 ECHELON MEDICAL CENTER
VOORHEES NJ
08043
US

V. Phone/Fax

Practice location:
  • Phone: 856-616-8440
  • Fax: 856-616-8445
Mailing address:
  • Phone: 856-616-8440
  • Fax: 856-616-8445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMA35216
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD038025L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: