Healthcare Provider Details

I. General information

NPI: 1639367162
Provider Name (Legal Business Name): ANKUR GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S PATTERSON BLVD STE 220
DAYTON OH
45402-2684
US

IV. Provider business mailing address

725 UNIVERSITY BLVD
DAYTON OH
45435-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-5350
  • Fax: 937-224-3112
Mailing address:
  • Phone: 937-245-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-098338
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number#390200000X
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35-098338
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: