Provider Demographics
NPI:1528273406
Name:GUPTA, ASHEESH (MD, MPH)
Entity type:Individual
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First Name:ASHEESH
Middle Name:
Last Name:GUPTA
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Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:14605 POTOMAC BRANCH DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3336
Mailing Address - Country:US
Mailing Address - Phone:703-490-1112
Mailing Address - Fax:
Practice Address - Street 1:14605 POTOMAC BRANCH DR
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3336
Practice Address - Country:US
Practice Address - Phone:703-490-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2022-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101256548207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine