MEDICARE: DATTA CONSULTANTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician

General Provider Information

NPI Number	:	1316675275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DATTA CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	132 ROSALIE RD
Second Line	:
City	:	NEWTON CENTER
State	:	MA
Zip	:	02459-3153
Country	:	US
Telephone Number	:	617-548-0184
Fax Number	:	617-609-7636

Provider Business Practice Location Address
First Line	:	132 ROSALIE RD
Second Line	:
City	:	NEWTON CENTER
State	:	MA
Zip	:	02459-3153
Country	:	US
Telephone Number	:	617-548-0184
Fax Number	:	617-609-7636

Authorized Official
Title or Position	:	OWNER/PSYCHIATRIST
Name	:	DR. DATTA GOURI
Credential	:	MD
Telephone Number	:	617-548-0184

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	06/01/2026

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