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General NPI Number Information
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NPI Number | 1497793020
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Entity Type | Organization
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Legal Business Name | MARYSVILLE ARTHRITIS CENTER, LLC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 500 LONDON AVE
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City | MARYSVILLE
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State | OH
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Zip | 43040-5512
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Country | US
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Telephone | 937-578-2275
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Fax | 937-578-4677
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Provider Business Mailing Address
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Address Line | 200 BRADENTON AVE
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City | DUBLIN
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State | OH
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Zip | 43017-7515
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Country | US
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Telephone | 614-793-1980
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ABHA R. GUPTA
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Credential | M.D.
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Telephone | 937-578-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 35-08-5561
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License Number State | OH
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