Healthcare Provider Details

I. General information

NPI: 1407872112
Provider Name (Legal Business Name): NARAINDER K. GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 1 SILVERSTEIN
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3400 SPRUCE ST 1 SILVERSTIEN
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3005
  • Fax:
Mailing address:
  • Phone: 215-662-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD422075
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD422075
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: