Provider Demographics
NPI:1609800655
Name:DR. GEETA DALAL
Entity Type:Organization
Organization Name:DR. GEETA DALAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-993-1943
Mailing Address - Street 1:4540 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:C SUITE 130
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6928
Mailing Address - Country:US
Mailing Address - Phone:337-993-1943
Mailing Address - Fax:
Practice Address - Street 1:4540 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:C SUITE 130
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6928
Practice Address - Country:US
Practice Address - Phone:337-993-1943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1365637Medicaid
LA4A466Medicare ID - Type UnspecifiedMEDICARE