Healthcare Provider Details

I. General information

NPI: 1366203416
Provider Name (Legal Business Name): PROF. KIRTI GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

240 ALBERT SABIN WAY # R.2303A
CINCINNATI OH
45229-2842
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-7109
  • Fax: 513-558-1951
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number75.000051
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number75.000051
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: