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General NPI Number Information
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NPI Number | 1962416669
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Entity Type | Individual
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Provider Name | PRAMOD KUMAR GUPTA MD
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4500 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-7167
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Country | US
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Telephone | 214-857-0185
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Fax | 214-857-0173
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Provider Business Mailing Address
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Address Line | 2704 OATES DR
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City | PLANO
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State | TX
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Zip | 75093-3364
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Country | US
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Telephone | 972-636-5904
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Fax | 775-855-4624
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01057371A
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License Number State | IN
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