Provider Demographics
NPI:1306973136
Name:MOHINDER K. GUPTA, M.D., INC.
Entity type:Organization
Organization Name:MOHINDER K. GUPTA, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-289-6466
Mailing Address - Street 1:21 SUGARBUSH CT
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9737
Mailing Address - Country:US
Mailing Address - Phone:419-289-6466
Mailing Address - Fax:419-281-4067
Practice Address - Street 1:21 SUGARBUSH CT
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-9737
Practice Address - Country:US
Practice Address - Phone:419-289-6466
Practice Address - Fax:419-281-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041004174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0460513OtherMEDICAID GROUP NUMBER
OH2059561Medicaid
OH2322025OtherMEDICAID GROUP NUMBER
OH2682726Medicaid
OH0343711Medicaid
OHMO9287132OtherGROUP MEDICARE PIN
OH0460513OtherMEDICAID GROUP NUMBER
OHA76388Medicare UPIN
OHSI4196822Medicare PIN
OHF99865Medicare UPIN
OH2322025OtherMEDICAID GROUP NUMBER
OHI42856Medicare UPIN
OHGU0438635Medicare PIN
OHMI4068171Medicare PIN