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General NPI Number Information
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NPI Number | 1194977066
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Entity Type | Organization
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Legal Business Name | AMITABH GUPTA MD PA
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 7895 SEMINOLE BLVD SUITE# 101
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City | SEMINOLE
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State | FL
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Zip | 33772-4891
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Country | US
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Telephone | 727-526-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 49TH ST N SUITE S 205
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City | ST PETERSBURG
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State | FL
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Zip | 33709-2146
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Country | US
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Telephone | 727-526-8000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMITABH P GUPTA
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Credential | MD
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Telephone | 727-526-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME85225
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License Number State | FL
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