Healthcare Provider Details

I. General information

NPI: 1649581067
Provider Name (Legal Business Name): SAURABH DASGUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 JASONWAY AVE
COLUMBUS OH
43214-2330
US

IV. Provider business mailing address

929 JASONWAY AVE
COLUMBUS OH
43214-2330
US

V. Phone/Fax

Practice location:
  • Phone: 862-371-5679
  • Fax:
Mailing address:
  • Phone: 862-371-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35.125060
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27984
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD81106
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: