MEDICARE: SAUMYAJIT DATTA, M.D., FAMILY MEDICINE, PLLC

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	207Q00000X	Family Medicine Physician	MD 00037210	WA

General Provider Information

NPI Number	:	1790939833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAUMYAJIT DATTA, M.D., FAMILY MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	1950 KEENE RD
Second Line	:	BLDG J
City	:	RICHLAND
State	:	WA
Zip	:	99352-7751
Country	:	US
Telephone Number	:	509-943-6800
Fax Number	:	509-491-3900

Provider Business Practice Location Address
First Line	:	1950 KEENE RD
Second Line	:	BLDG J
City	:	RICHLAND
State	:	WA
Zip	:	99352-7751
Country	:	US
Telephone Number	:	509-943-6800
Fax Number	:	509-491-3900

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SAUMYAJIT NMI DATTA
Credential	:	M.D.
Telephone Number	:	509-943-6800

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	02/09/2017

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