Provider Demographics
NPI:1053357376
Name:GUPTA, DHAM KRISHAN (MD)
Entity type:Individual
Prefix:DR
First Name:DHAM
Middle Name:KRISHAN
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:260 MEADOWVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3557
Mailing Address - Country:US
Mailing Address - Phone:716-816-2221
Mailing Address - Fax:716-885-4852
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-3465
Practice Address - Fax:716-898-4289
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1537502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY89K521OtherPIN #
NY89K521OtherPIN #
NYB35579Medicare UPIN