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General NPI Number Information
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NPI Number | 1699868505
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Entity Type | Organization
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Legal Business Name | MANISH RAJ GUPTA, MD, INC.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 1050 ISAAC STREETS DR SUITE 136
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City | OREGON
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State | OH
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Zip | 43616-3291
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Country | US
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Telephone | 419-696-5656
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 ISAAC STREETS DR SUITE 136
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City | OREGON
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State | OH
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Zip | 43616-3291
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Country | US
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Telephone | 419-696-5656
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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. MANISH RAJ GUPTA
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Credential | MD
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Telephone | 419-696-5656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 35076763G
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License Number State | OH
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