| Ganesh P Gupta Mdpa | |
|
1610 James Bowie Dr Ste A114 Baytown TX 77520-3383 | |
| (281) 422-3576 | |
| (281) 422-0295 |
| Full Name | Ganesh P Gupta Mdpa |
|---|---|
| Speciality | Family Medicine |
| Location | 1610 James Bowie Dr Ste A114, Baytown, Texas |
| Authorized Official Name and Position | Ganesh P Gupta (PRESIDENT) |
| Authorized Official Contact | 2814223576 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ganesh P Gupta Mdpa Po Box 975 Baytown TX 77522-0975 Ph: (281) 422-3576 | Ganesh P Gupta Mdpa 1610 James Bowie Dr Ste A114 Baytown TX 77520-3383 Ph: (281) 422-3576 |
| NPI Number | 1457657090 |
|---|---|
| Provider Enumeration Date | 01/30/2011 |
| Last Update Date | 01/30/2011 |
| Medicare PECOS PAC ID | 3577743830 |
|---|---|
| Medicare Enrollment ID | O20110203001116 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457657090 | NPI | - | NPPES |
| 129715206 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | J4649 (Texas) | Primary |
| Provider Name | Ganesh P Gupta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316910433 PECOS PAC ID: 7810177169 Enrollment ID: I20110203001037 |
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