Provider Demographics
NPI:1386041945
Name:PALO ALTO VA
Entity Type:Organization
Organization Name:PALO ALTO VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FEE BASIS RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NILOY
Authorized Official - Middle Name:
Authorized Official - Last Name:DASGUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-265-9715
Mailing Address - Street 1:808 COLEMAN AVE
Mailing Address - Street 2:APARTMENT 18
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2450
Mailing Address - Country:US
Mailing Address - Phone:571-265-9715
Mailing Address - Fax:
Practice Address - Street 1:808 COLEMAN AVE
Practice Address - Street 2:APARTMENT 18
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2450
Practice Address - Country:US
Practice Address - Phone:571-265-9715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA129357282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital