Provider Demographics
NPI:1003068412
Name:DASGUPTA, SUSMITA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSMITA
Middle Name:
Last Name:DASGUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSMITA
Other - Middle Name:
Other - Last Name:KAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13920 85TH DR
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2728
Mailing Address - Country:US
Mailing Address - Phone:205-567-2502
Mailing Address - Fax:
Practice Address - Street 1:79-25 WINCHESTER BLVD
Practice Address - Street 2:MEDICAL EDUCATION, CREEDMOOR PSYCHIATRIC CENTER
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427
Practice Address - Country:US
Practice Address - Phone:718-264-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAC55183678252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry