MEDICARE: DR. VENKATA S GUPTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	IMLC.MD.70130552	WA
2	208000000X	Pediatrics Physician	35.150240	OH
3	208000000X	Pediatrics Physician	036-172098	IL

General Provider Information

NPI Number	:	1033630785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VENKATA S GUPTA MD

Provider Business Mailing Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 7009
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3026
Country	:	US
Telephone Number	:	312-404-8849
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 7009
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3026
Country	:	US
Telephone Number	:	312-404-8849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	05/28/2026

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