Individual
SURYA N GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4803 KENTUCKY STREET, CAMC PEDIATRIC NEUROLOGY, SOUTH CHARLESTON, WV 25309-1547
(304) 766-7695
(603) 663-3229
Mailing address
PO BOX 1547, CAMC PEDIATRIC NEUROLOGY, CHARLESTON, WV 25326-1547
(304) 388-7183
(304) 388-7176
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
MD057895L
PA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
15026
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016630190001
—
PA
Enumeration date
10/13/2005
Last updated
07/18/2013
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