Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 35044556 | OH |
NPI | 1093797318 |
---|---|
Provider Name | Manju Gupta |
First Address | Loveland, OH 45140-6966 |
Second Address | New Richmond, OH 45157-8566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 10/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0418766 | (05) | OH |
D33281 | (02) | OH |