MEDICARE: MOHINDER K. GUPTA, M.D., INC.

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	174400000X	Specialist	35041004	OH

General Provider Information

NPI Number	:	1578578217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHINDER K. GUPTA, M.D., INC.

Provider Business Mailing Address
First Line	:	21 SUGARBUSH CT
Second Line	:
City	:	ASHLAND
State	:	OH
Zip	:	44805-9737
Country	:	US
Telephone Number	:	419-289-6466
Fax Number	:	419-281-4067

Provider Business Practice Location Address
First Line	:	1456 PARK AVE W
Second Line	:	SUITE P
City	:	MANSFIELD
State	:	OH
Zip	:	44906-2700
Country	:	US
Telephone Number	:	419-289-6466
Fax Number	:	419-281-4067

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOHINDER K. GUPTA
Credential	:	M.D.
Telephone Number	:	419-289-6466

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	11/30/2007

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