Individual
PANKAJ GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4102 N ROXBORO ST, NORTH CAROLINA EYE EAR NOSE AND THROAT, DURHAM, NC 27704-2122
(919) 595-2000
(919) 595-2190
Mailing address
4102 N ROXBORO ST, NORTH CAROLINA EYE EAR NOSE AND THROAT, DURHAM, NC 27704-2122
(919) 595-2000
(919) 595-2190
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
41792-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023442
MEDICARE PTAN
NC
Enumeration date
06/15/2006
Last updated
12/13/2023
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