Provider Demographics
NPI:1235317850
Name:VISHAL DATTA MD PA
Entity Type:Organization
Organization Name:VISHAL DATTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-834-2551
Mailing Address - Street 1:1 ASHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-9000
Mailing Address - Country:US
Mailing Address - Phone:202-834-2551
Mailing Address - Fax:331-204-0812
Practice Address - Street 1:1 ASHWOOD LN
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-9000
Practice Address - Country:US
Practice Address - Phone:202-834-2551
Practice Address - Fax:331-204-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI05542Medicare UPIN