MEDICARE: VINITA GUPTA M.D.

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	207RH0003X	Hematology & Oncology Physician	01093431A	IN
2	207RH0003X	Hematology & Oncology Physician	249877	NY

General Provider Information

NPI Number	:	1710181870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINITA GUPTA M.D.

Provider Business Mailing Address
First Line	:	450 CLARKSON AVE
Second Line	:	PO BOX 20
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2098
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 CLARKSON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2098
Country	:	US
Telephone Number	:	718-270-2785
Fax Number	:	718-270-1578

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	07/17/2024

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