Healthcare Provider Details

I. General information

NPI: 1558616367
Provider Name (Legal Business Name): KAVERI GUPTA M.D., FRCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3569 8TH LINE ROAD
WINCHESTER ONTARIO
K0C 2K0
CA

IV. Provider business mailing address

3569 8TH LINE ROAD
WINCHESTER ONTARIO
K0C 2K0
CA

V. Phone/Fax

Practice location:
  • Phone: 613-821-4704
  • Fax: 613-482-5110
Mailing address:
  • Phone: 613-821-4704
  • Fax: 613-482-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD2012-0531
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: