Healthcare Provider Details

I. General information

NPI: 1992749410
Provider Name (Legal Business Name): BHARAT GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 BUFFALO RD BLDG. 800
ROCHESTER NY
14624-1360
US

IV. Provider business mailing address

2300 BUFFALO RD BLDG. 800
ROCHESTER NY
14624-1360
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-6370
  • Fax: 585-368-3371
Mailing address:
  • Phone: 585-368-6370
  • Fax: 585-368-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number186273
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: