Provider Demographics
NPI:1932228129
Name:GUPTA, CHETAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHETAN
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 BEECHMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4119
Mailing Address - Country:US
Mailing Address - Phone:513-232-9100
Mailing Address - Fax:513-232-3333
Practice Address - Street 1:7300 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4119
Practice Address - Country:US
Practice Address - Phone:513-232-9100
Practice Address - Fax:513-232-9100
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35094424207Q00000X, 208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3004895Medicaid
OH3004895Medicaid