Healthcare Provider Details

I. General information

NPI: 1508895640
Provider Name (Legal Business Name): SURESH GUPTA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 12/26/2022
Certification Date: 12/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WOODMAN DR
DAYTON OH
45432
US

IV. Provider business mailing address

1010 WOODMAN DR
DAYTON OH
45432-1400
US

V. Phone/Fax

Practice location:
  • Phone: 937-424-2215
  • Fax: 937-252-1224
Mailing address:
  • Phone: 937-424-2215
  • Fax: 937-252-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SAPNA GUPTA
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 937-620-0720