Healthcare Provider Details

I. General information

NPI: 1629479639
Provider Name (Legal Business Name): GUPTA PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 WESTBOURNE DR
CINCINNATI OH
45248-5107
US

IV. Provider business mailing address

PO BOX 706346
CINCINNATI OH
45270-6346
US

V. Phone/Fax

Practice location:
  • Phone: 513-421-4099
  • Fax: 513-347-2116
Mailing address:
  • Phone: 513-421-4099
  • Fax: 513-347-2116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BABU V GUPTA
Title or Position: PRESIDENT
Credential: MD
Phone: 513-421-4099