Provider Demographics
NPI:1861208969
Name:GHANSHYAM GUPTA, M.D. PC
Entity type:Organization
Organization Name:GHANSHYAM GUPTA, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-838-4224
Mailing Address - Street 1:10110 MOLECULAR DR STE 111
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7538
Mailing Address - Country:US
Mailing Address - Phone:301-838-4224
Mailing Address - Fax:301-838-4244
Practice Address - Street 1:2415 MUSGROVE RD STE 109
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5221
Practice Address - Country:US
Practice Address - Phone:301-838-4224
Practice Address - Fax:301-838-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty