Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | MD17519 | RI |
NPI | 1124402961 |
---|---|
Provider Name | Dr. Medhavi Gupta |
First Address | Providence, RI 02903 |
Second Address | Providence, RI 02903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2015 |
Last Update Date | 17/12/2021 |