Provider Demographics
NPI:1184649907
Name:DALAL, VINAY (MD)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:
Last Name:DALAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-348-8772
Practice Address - Street 1:413 WEST ROSEDALE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4808
Practice Address - Country:US
Practice Address - Phone:817-348-8082
Practice Address - Fax:817-348-8772
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5294208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162777001Medicaid
P00096728OtherRAILROAD MEDICARE