MEDICARE: DR. INDRANIL DASGUPTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD067078L	PA
2	207RC0000X	Cardiovascular Disease Physician	25MA07005600	NJ
3	207RC0000X	Cardiovascular Disease Physician	MD067078L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205856143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INDRANIL DASGUPTA M.D.

Provider Business Mailing Address
First Line	:	8001 ROOSEVELT BLVD
Second Line	:	SUITE 403
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3038
Country	:	US
Telephone Number	:	215-676-8300
Fax Number	:	215-698-7707

Provider Business Practice Location Address
First Line	:	8001 ROOSEVELT BLVD
Second Line	:	SUITE 403
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3038
Country	:	US
Telephone Number	:	215-676-8300
Fax Number	:	215-698-7707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	05/31/2017

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