Individual
SANDEEPKUMAR JAGDISHBHAI GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 WILLIAM PENN PLZ, DURHAM, NC 27704-2150
(919) 220-5255
(919) 220-6971
Mailing address
120 WILLIAM PENN PLZ, DURHAM, NC 27704-2150
(919) 220-5255
(919) 220-6971
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
56620
TN
207R00000X
Internal Medicine Physician
81788
GA
207RR0500X
Rheumatology Physician
Primary
2020-04827
NC
208M00000X
Hospitalist Physician
2020-04827
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528485729
—
NC
01
—
2020-04827
NC MEDICAL LICENSE
NC
Enumeration date
03/25/2014
Last updated
05/24/2023
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