Provider Demographics
NPI:1235378563
Name:DUTTA, ANKHI (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ANKHI
Middle Name:
Last Name:DUTTA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17580 INTERSTATE 45 S STE WA360
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4972
Mailing Address - Country:US
Mailing Address - Phone:936-267-5000
Mailing Address - Fax:
Practice Address - Street 1:17580 INTERSTATE 45 S
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-4972
Practice Address - Country:US
Practice Address - Phone:936-267-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1311208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187842301Medicaid
TX671861Medicare Oscar/Certification