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NPI Code Detail

MEDICARE: SANDEEP GUPTA M.D.

MEDICARE: SANDEEP 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
1207RC0000XCardiovascular Disease Physician35072259OH
2207RC0001XClinical Cardiac Electrophysiology Physician35072259OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4GU4106315OTHEROHMEDICARE (OHIO) INDIVIDUAL NPI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1283835OTHEROHAMERIGROUP
2000000522400OTHEROHANTHEM BCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5208679830028OTHEROHCARESOURCE
62027989OTHEROHMOLINA HEALTHCARE

General Provider Information

NPI Number : 1720055379
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDEEP GUPTA M.D.
Provider Business Mailing Address
First Line : 103 MCKNIGHT DR
Second Line : SUITE A
City : MIDDLETOWN
State : OH
Zip : 45044-4890
Country : US
Telephone Number : 513-217-6400
Fax Number : 513-217-6037
Provider Business Practice Location Address
First Line : 103 MCKNIGHT DR
Second Line : SUITE A
City : MIDDLETOWN
State : OH
Zip : 45044-4890
Country : US
Telephone Number : 513-217-6400
Fax Number : 513-217-6037
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2006
Last Update Date : 11/21/2016

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Directions to “ SANDEEP GUPTA M.D.” Practice Location

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