Healthcare Provider Details

I. General information

NPI: 1598763856
Provider Name (Legal Business Name): BABU V GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 EXECUTIVE PARK DR STE 320
CINCINNATI OH
45241-4015
US

IV. Provider business mailing address

PO BOX 965
MIDDLETOWN OH
45044-0965
US

V. Phone/Fax

Practice location:
  • Phone: 513-563-0488
  • Fax:
Mailing address:
  • Phone: 513-563-0488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29831
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number35066574
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: