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General NPI Number Information
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NPI Number | 1578578217
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Entity Type | Organization
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Legal Business Name | MOHINDER K. GUPTA, M.D., INC.
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 1456 PARK AVE W SUITE P
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City | MANSFIELD
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State | OH
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Zip | 44906-2700
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Country | US
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Telephone | 419-289-6466
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Fax | 419-281-4067
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Provider Business Mailing Address
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Address Line | 21 SUGARBUSH CT
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City | ASHLAND
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State | OH
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Zip | 44805-9737
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Country | US
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Telephone | 419-289-6466
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Fax | 419-281-4067
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHINDER K. GUPTA
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Credential | M.D.
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Telephone | 419-289-6466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35041004
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License Number State | OH
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