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General NPI Number Information
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NPI Number | 1215963038
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Entity Type | Individual
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Provider Name | SANJAY GUPTA MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 333 E CITY LINE AVE STE PL20
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1507
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Country | US
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Telephone | 610-664-3000
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Fax | 610-664-3003
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Provider Business Mailing Address
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Address Line | 27 WYNNEWOOD DR
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City | VOORHEES
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State | NJ
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Zip | 08043-1657
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Country | US
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Telephone | 610-664-3000
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Fax | 610-664-3003
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD065417L
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License Number State | PA
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