Individual
BHAWNA GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5520 PARK AVE, STE. 206, TRUMBULL, CT 06611-3463
(203) 371-7177
Mailing address
9 WASHINGTON AVE, STE # 2D, HAMDEN, CT 06518-3267
(203) 371-7177
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45710
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45710
CT STATE LICENSE
CT
Enumeration date
07/18/2005
Last updated
11/18/2014
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