Healthcare Provider Details

I. General information

NPI: 1063466795
Provider Name (Legal Business Name): RAJNISH K GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 BUCKLES CT N STE 1A
COLUMBUS OH
43230-6928
US

IV. Provider business mailing address

3825 TRUEMAN CT
HILLIARD OH
43026-2496
US

V. Phone/Fax

Practice location:
  • Phone: 614-986-0125
  • Fax: 614-237-1646
Mailing address:
  • Phone: 614-794-4500
  • Fax: 614-794-4976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.063590
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: