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General NPI Number Information
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NPI Number | 1235317850
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Entity Type | Organization
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Legal Business Name | VISHAL DATTA MD PA
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 1 ASHWOOD LN
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City | MALVERN
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State | PA
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Zip | 19355-9000
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Country | US
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Telephone | 202-834-2551
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Fax | 331-204-0812
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Provider Business Mailing Address
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Address Line | 1 ASHWOOD LN
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City | MALVERN
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State | PA
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Zip | 19355-9000
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Country | US
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Telephone | 202-834-2551
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Fax | 331-204-0812
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Authorized Official
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Title or Position | PRESIDENT
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Name | VISHAL DATTA
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Credential | M.D.
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Telephone | 202-834-2551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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