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Individual

KRISHANU BAPPA GUPTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D., PH.D.

Contact information

Practice address
525 BROAD ST, SUITE 202, CUMBERLAND, RI 02864-6919
(401) 727-4600
(401) 727-4690
Mailing address
525 BROAD ST, SUITE 202, CUMBERLAND, RI 02864-6919
(401) 727-4600
(401) 727-4690

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
210605
MA
2085R0202X
Diagnostic Radiology Physician
Primary
MD11080
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
16-00084
UNITED HEALTHCARE
RI
01
21093-9
BCBS - RI
RI
05
7010331
RI
Enumeration date
11/04/2005
Last updated
12/06/2011
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