Healthcare Provider Details

I. General information

NPI: 1730143926
Provider Name (Legal Business Name): RAMESH CHANDRA GUPTA I M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 PARK AVE SUITE 409
MEMPHIS TN
38119-5202
US

IV. Provider business mailing address

6005 PARK AVE SUITE 409
MEMPHIS TN
38119-5202
US

V. Phone/Fax

Practice location:
  • Phone: 901-681-9670
  • Fax: 901-685-9023
Mailing address:
  • Phone: 901-681-9670
  • Fax: 901-685-9023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD0000014398
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: