Provider Demographics
NPI:1659336485
Name:DATTA, SUBHAJIT (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBHAJIT
Middle Name:
Last Name:DATTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 BEAN OLLER RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-9220
Mailing Address - Country:US
Mailing Address - Phone:740-369-6516
Mailing Address - Fax:
Practice Address - Street 1:1040 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-383-7980
Practice Address - Fax:740-383-3040
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH092044208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
020034670OtherRAILROAD MEDICARE
NYF92124Medicare UPIN
OHH160230Medicare PIN
NY12168EMedicare ID - Type Unspecified