MEDICARE: ASHEESH GUPTA M.D., M.P.H.

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	0101256548	VA

General Provider Information

NPI Number	:	1528273406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHEESH GUPTA M.D., M.P.H.

Provider Business Mailing Address
First Line	:	14605 POTOMAC BRANCH DR
Second Line	:	SUITE 300
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3336
Country	:	US
Telephone Number	:	703-490-1112
Fax Number	:

Provider Business Practice Location Address
First Line	:	14605 POTOMAC BRANCH DR
Second Line	:	SUITE 300
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3336
Country	:	US
Telephone Number	:	703-490-1112
Fax Number	:

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

Provider Enumeration Date	:	05/13/2007
Last Update Date	:	10/04/2022

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