Individual
CHANDAN GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20 OVERBROOK DR, SUITE C, MONROE, OH 45050-3101
(513) 539-7356
(513) 539-7782
Mailing address
3170 KETTERING BLVD BLDG B, MORAINE, OH 45439-1924
(379) 913-1889
(372) 239-8119
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
72286
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2019121
—
OH
Enumeration date
08/09/2005
Last updated
03/23/2022
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