Healthcare Provider Details

I. General information

NPI: 1568685022
Provider Name (Legal Business Name): NEERAJ GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9380F FORESTWOOD LANE
MANASSAS VA
20110
US

IV. Provider business mailing address

9380F FORESTWOOD LANE
MANASSAS VA
20110
US

V. Phone/Fax

Practice location:
  • Phone: 903-330-3277
  • Fax: 703-368-7257
Mailing address:
  • Phone: 903-330-3277
  • Fax: 703-368-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberVA0101046623
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: