Provider Demographics
NPI:1033476320
Name:BELLA H. DATTANI, MD PA
Entity Type:Organization
Organization Name:BELLA H. DATTANI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:H
Authorized Official - Last Name:DATTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-678-3255
Mailing Address - Street 1:1035 N ORLANDO AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4850
Mailing Address - Country:US
Mailing Address - Phone:407-678-3255
Mailing Address - Fax:407-599-5966
Practice Address - Street 1:1035 N ORLANDO AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4850
Practice Address - Country:US
Practice Address - Phone:407-678-3255
Practice Address - Fax:407-599-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGB664AMedicare PIN