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General NPI Number Information
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NPI Number | 1982641049
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Entity Type | Individual
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Provider Name | PRANAY GUPTA MD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 3660 BOULEVARD
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-1345
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Country | US
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Telephone | 804-243-2020
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Fax | 804-754-1428
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Provider Business Mailing Address
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Address Line | 809 CLUB RIDGE CT
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City | CHESTER
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State | VA
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Zip | 23836-2745
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Country | US
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Telephone | 804-243-2020
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Fax | 804-754-1428
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101230970
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License Number State | VA
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