Healthcare Provider Details

I. General information

NPI: 1245202324
Provider Name (Legal Business Name): AKASH GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 LONDON GROVEPORT RD
GROVE CITY OH
43123-9723
US

IV. Provider business mailing address

1810 MACKENZIE DR 2ND FLOOR
COLUMBUS OH
43220-2967
US

V. Phone/Fax

Practice location:
  • Phone: 614-275-4300
  • Fax: 614-275-4748
Mailing address:
  • Phone: 614-273-2250
  • Fax: 614-273-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35085237G
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: