Provider Demographics
NPI:1366489361
Name:SENGUPTA, MALA (MD)
Entity Type:Individual
Prefix:
First Name:MALA
Middle Name:
Last Name:SENGUPTA
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:P.O. BOX 741087
Mailing Address - Street 2:
Mailing Address - City:ATLANTA, GA -
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1087
Mailing Address - Country:US
Mailing Address - Phone:941-627-6128
Mailing Address - Fax:941-764-7071
Practice Address - Street 1:21298 OLEAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6705
Practice Address - Country:US
Practice Address - Phone:941-627-6128
Practice Address - Fax:941-764-7071
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43830207ZC0500X, 207ZP0102X
MI4301057149207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630314Medicare PIN