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General NPI Number Information
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NPI Number | 1114162625
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Entity Type | Individual
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Provider Name | VISHAL GUPTA MD
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Gender | Male
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 03/02/2025
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Provider Practice Location Address
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Address Line | 880 N TENNESSEE AVE STE 104
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City | MARTINSBURG
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State | WV
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Zip | 25401-9401
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Country | US
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Telephone | 304-596-6893
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 67000 DEPARTMENT 272801
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City | DETROIT
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State | MI
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Zip | 48267-0002
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Country | US
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Telephone | 517-817-7618
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Fax | 517-817-7639
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301093433
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301093433
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 33798
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License Number State | WV
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