Provider Demographics
NPI:1093988685
Name:ELLEN J. DUTTA, MD, PA
Entity Type:Organization
Organization Name:ELLEN J. DUTTA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:DUTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-250-4016
Mailing Address - Street 1:16901 DALLAS PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5226
Mailing Address - Country:US
Mailing Address - Phone:972-250-4016
Mailing Address - Fax:972-250-4017
Practice Address - Street 1:16901 DALLAS PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5226
Practice Address - Country:US
Practice Address - Phone:972-250-4016
Practice Address - Fax:972-250-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2872207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty