Healthcare Provider Details

I. General information

NPI: 1710236245
Provider Name (Legal Business Name): ATUL GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

1100 9TH AVE M4-PFS
SEATTLE WA
98101-2756
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-6600
  • Fax:
Mailing address:
  • Phone: 206-515-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number60678923
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number60678923
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: