Individual
PRAVEEN KUMAR GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4080 CHAIN BRIDGE ROAD, FAIRFAX, VA 22030
(703) 246-4949
(703) 352-0217
Mailing address
4080 CHAIN BRIDGE RD, FAIRFAX, VA 22030-4080
(703) 246-4949
(703) 352-0217
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
010154944
VA
Other
Enumeration date
06/01/2012
Last updated
06/01/2012
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