Healthcare Provider Details

I. General information

NPI: 1912796574
Provider Name (Legal Business Name): IPSHITA DUTTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EAST BROAD STREET
RICHMOND VA
23219
US

IV. Provider business mailing address

1200 E. BROAD STREET BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-2467
  • Fax: 804-828-5775
Mailing address:
  • Phone: 804-828-9783
  • Fax: 804-828-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1912796574
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: