Organization
SANJIV GUPTA M.D. P.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANJIV GUPTA MD (PRESIDENT/OWNER)
(606) 474-2200
Entity
Organization
Contact information
Practice address
300 ST HWY 1947, SUITE A, GRAYSON, KY 41143-1947
(606) 474-2200
(606) 474-2205
Mailing address
PO BOX 1620, 300 ST HWY 1947, GRAYSON, KY 41143-5620
(606) 474-2200
(606) 474-2205
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
32686
KY
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
32686
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2016446
—
OH
05
—
64326861
—
KY
Enumeration date
08/07/2006
Last updated
04/28/2020
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