Healthcare Provider Details

I. General information

NPI: 1043405244
Provider Name (Legal Business Name): RISHI GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 06/30/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 SENATOR KEATING BLVD BUILDING E. SUITE 340
ROCHESTER NY
14618
US

IV. Provider business mailing address

UNIVERSITY OF ROCHESTER 601 ELMWOOD AVE
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2647
  • Fax: 410-328-7305
Mailing address:
  • Phone: 585-275-2647
  • Fax: 585-275-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number295796
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number35 121122
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberD82255
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: