Healthcare Provider Details

I. General information

NPI: 1861483380
Provider Name (Legal Business Name): GEETA N DALAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 AMBASSADOR CAFFERY PKWY STE C130
LAFAYETTE LA
70508-6928
US

IV. Provider business mailing address

4540 AMBASSADOR CAFFERY PKWY STE C130
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 NumberL7239R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: