Healthcare Provider Details

I. General information

NPI: 1003286998
Provider Name (Legal Business Name): GEETA N DALAL MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 AMBASSADOR CAFFERY PKWY SUITE C-130
LAFAYETTE LA
70508-6928
US

IV. Provider business mailing address

4540 AMBASSADOR CAFFERY PKWY SUITE C-130
LAFAYETTE LA
70508-6928
US

V. Phone/Fax

Practice location:
  • Phone: 337-993-1943
  • Fax: 337-993-1944
Mailing address:
  • Phone: 337-993-1943
  • Fax: 337-993-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEETA DALAL
Title or Position: OWNER
Credential: M.D.
Phone: 337-993-1943