Active NPI
Raj K Gupta, MD
- Pediatrics Physician
- West Carrollton, OH
National Provider Identifier
1124103403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 35100034
- Practice address
- 31 N Locust St
West Carrollton, OH 45449-1407 - Phone
- (937) 898-7750
- NPI assigned
- Oct 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 35100034 | OH | Primary |
Addresses
Primary practice location
31 N Locust St
West Carrollton, OH 45449-1407
Mailing address
117 South Main Street
Reibold Building
Dayton, OH 45422
Phone (937) 225-4954
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0317802 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35100034 | OH | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124103403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 SOUTH MAIN STREET",
"address_2": "REIBOLD BUILDING",
"city": "DAYTON",
"state": "OH",
"postal_code": "45422",
"telephone_number": "937-225-4954",
"fax_number": "937-496-3071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 N LOCUST ST",
"city": "WEST CARROLLTON",
"state": "OH",
"postal_code": "454491407",
"telephone_number": "937-898-7750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUPTA",
"first_name": "RAJ",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35100034",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0317802",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Carrollton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.