Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 35-07-6763-G | OH |
NPI | 1124005863 |
---|---|
Provider Name | Dr. Manish R Gupta |
First Address | Oregon, OH 43616-3291 |
Second Address | Oregon, OH 43616-3291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2005 |
Last Update Date | 06/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2492922 | (05) | OH |
I08513 | (02) |