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General NPI Number Information
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NPI Number | 1225089725
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Entity Type | Individual
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Provider Name | RAJEEV GUPTA MD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 1621 W MORRIS BLVD STE C
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City | MORRISTOWN
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State | TN
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Zip | 37813-2832
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Country | US
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Telephone | 423-317-7412
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Fax | 423-317-7415
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Provider Business Mailing Address
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Address Line | 1621 W MORRIS BLVD STE C
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City | MORRISTOWN
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State | TN
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Zip | 37813-2832
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Country | US
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Telephone | 423-317-7412
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Fax | 423-317-7415
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | MD0000035645
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License Number State | TN
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