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General NPI Number Information
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NPI Number | 1932408218
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Entity Type | Organization
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Legal Business Name | SANJIV GUPTA, M.D., P.S.C.
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Dates
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Enumeration Date | 03/25/2011
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Last Update Date | 03/25/2011
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Provider Practice Location Address
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Address Line | 101 ASHLAND DR
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City | ASHLAND
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State | KY
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Zip | 41101-7001
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Country | US
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Telephone | 606-324-1996
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Fax | 606-833-2430
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Provider Business Mailing Address
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Address Line | 101 ASHLAND DR
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City | ASHLAND
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State | KY
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Zip | 41101-7001
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Country | US
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Telephone | 606-324-1996
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Fax | 606-833-2430
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. RAJNI GUPTA
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Credential |
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Telephone | 606-324-1996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 32686
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License Number State | KY
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