Provider Demographics
NPI:1659543312
Name:P.C.DUTTA,M.D.,P.A.
Entity Type:Organization
Organization Name:P.C.DUTTA,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARITOSH
Authorized Official - Middle Name:CHANDRA
Authorized Official - Last Name:DUTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-238-9065
Mailing Address - Street 1:275 W CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3601
Mailing Address - Country:US
Mailing Address - Phone:972-238-9065
Mailing Address - Fax:
Practice Address - Street 1:275 W CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3601
Practice Address - Country:US
Practice Address - Phone:972-238-9065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE 7900207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB87642OtherUPIN
TX8BC670OtherBCBS
TX2287642OtherBCBS BLUE LINK
TX4063099OtherAETNA
TX2892757001OtherCIGNA PAL
TX2892757001OtherCIGNA PAL