Doctor Name: | DR. GLORIA GRACE GUPTILL |
NPI Number: | 1295994002 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 62714 |
Business Practice Address: | 250 Delaware Ave Delmar, NY - 120541420 |
Business Phone Number: | 5184398077 |
Business Fax Number: | 5184398070 |
Mailing Address: | 711 Troy Schenectady Rd, Suite 201 LATHAM |
State: | NY |
Postal Code: | 121102442 |
Phone Number: | 5182130478 |
Fax Number: | 5187823799 |
NPI Enumeration Date: | 06/06/2008 |
NPI Last Update Date: | 08/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 62714 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |