Healthcare Provider Details

I. General information

NPI: 1215170972
Provider Name (Legal Business Name): NILOY DASGUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BROADVIEW AVE STE 102
WARRENTON VA
20186-2036
US

IV. Provider business mailing address

PO BOX 101
STEVENSON MD
21153-0101
US

V. Phone/Fax

Practice location:
  • Phone: 888-628-8272
  • Fax:
Mailing address:
  • Phone: 888-628-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberC1-0011791
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberC1-0011791
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC1-0011791
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0095506
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: