Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS013699 | PA |
N | 207QS0010X | Family Doctor - Sports Medicine | 25MB09249700 | NJ |
Y | 207QS0010X | Family Doctor - Sports Medicine | OS013699 | PA |
NPI | 1306097332 |
---|---|
Provider Name | Sunny Gupta |
First Address | Philadelphia, PA 19107-4414 |
Second Address | Philadelphia, PA 19107-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2008 |
Last Update Date | 10/11/2015 |