Provider Demographics
NPI:1619395746
Name:DIBBA, PRATIMA (MD)
Entity Type:Individual
Prefix:
First Name:PRATIMA
Middle Name:
Last Name:DIBBA
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 1:201 E 65TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6701
Mailing Address - Country:US
Mailing Address - Phone:212-223-0996
Mailing Address - Fax:212-249-7580
Practice Address - Street 1:201 E 65TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6701
Practice Address - Country:US
Practice Address - Phone:212-223-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-05
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294323207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program