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General NPI Number Information
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NPI Number | 1821339755
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Entity Type | Organization
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Legal Business Name | B RAI GUPTA MD PA
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Dates
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Enumeration Date | 03/01/2013
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 3300 W LAKE MARY BLVD SUITE 220
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City | LAKE MARY
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State | FL
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Zip | 32746-3570
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Country | US
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Telephone | 407-321-7111
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Fax | 407-321-7446
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Provider Business Mailing Address
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Address Line | 3300 W LAKE MARY BLVD SUITE 220
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City | LAKE MARY
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State | FL
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Zip | 32746-3570
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Country | US
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Telephone | 407-321-7111
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Fax | 407-321-7446
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Authorized Official
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Title or Position | BUSINESS ACCOUNT MANAGER
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Name | MRS. SUSAN L HOLLAND
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Credential | BSN
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Telephone | 407-321-7111
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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 |
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License Number State | FL
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