Healthcare Provider Details

I. General information

NPI: 1255885836
Provider Name (Legal Business Name): DR. ARUN K GUPTA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10560 MAIN ST STE 210
FAIRFAX VA
22030-7176
US

IV. Provider business mailing address

9306 FOREST POINT CIR
MANASSAS VA
20110-4700
US

V. Phone/Fax

Practice location:
  • Phone: 703-273-3616
  • Fax: 703-330-5051
Mailing address:
  • Phone: 703-330-3322
  • Fax: 703-330-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101226689
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101226689
License Number StateVA

VIII. Authorized Official

Name: ARUN K GUPTA
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 703-330-3322