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General NPI Number Information
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NPI Number | 1194099408
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Entity Type | Organization
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Legal Business Name | CHHAVI GUPTA, M.D. PLLC
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 2841 HARTLAND RD SUITE 405
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City | FALLS CHURCH
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State | VA
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Zip | 22043-3500
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Country | US
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Telephone | 703-267-5752
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Fax | 703-621-3786
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Provider Business Mailing Address
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Address Line | 9181 TOPAZ ST
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City | FAIRFAX
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State | VA
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Zip | 22031-1344
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. CHHAVI GUPTA
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Credential | M.D.
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Telephone | 703-267-5752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0101249449
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License Number State | VA
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