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General NPI Number Information
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NPI Number | 1265638787
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Entity Type | Individual
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Provider Name | SAMARESH DASGUPTA D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 5501 OLD YORK RD
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3018
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Country | US
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Telephone | 215-456-6336
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Fax | 215-456-6601
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Provider Business Mailing Address
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Address Line | 929 COX RD
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3937
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | OS014627
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | OT012210
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25MB08949800
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License Number State | NJ
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