Provider Demographics
NPI:1790896082
Name:DALAL, UMESH I (MD)
Entity Type:Individual
Prefix:
First Name:UMESH
Middle Name:I
Last Name:DALAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 N 9TH ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-6501
Mailing Address - Country:US
Mailing Address - Phone:610-628-7920
Mailing Address - Fax:610-821-2853
Practice Address - Street 1:1619 N 9TH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6501
Practice Address - Country:US
Practice Address - Phone:610-628-7920
Practice Address - Fax:610-821-2853
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 046225-L207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12938470006Medicaid
F 06997Medicare UPIN
PA724490Medicare PIN