Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2390091 | NY |
Y | 207VX0201X | Gynecologic Oncologist | 54784 | CT |
NPI | 1134209695 |
---|---|
Provider Name | Divya Gupta |
First Address | Hartford, CT 06105-1770 |
Second Address | Hartford, CT 06105-1770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 04/04/2016 |