Healthcare Provider Details

I. General information

NPI: 1295178382
Provider Name (Legal Business Name): ANSHULI GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-3322
  • Fax: 614-566-1073
Mailing address:
  • Phone: 614-566-3322
  • Fax: 614-566-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35126707
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35126707
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: