Provider Demographics
NPI:1801868070
Name:ROY, DIPANWITA (MD)
Entity Type:Individual
Prefix:
First Name:DIPANWITA
Middle Name:
Last Name:ROY
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 1:8556 BUSTLETON AVENUE
Mailing Address - Street 2:EINSTEIN PLAZA PENNYPACK PEDIATRICS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120
Mailing Address - Country:US
Mailing Address - Phone:215-698-9200
Mailing Address - Fax:215-332-4395
Practice Address - Street 1:8556 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-338-4949
Practice Address - Fax:215-332-4395
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049503L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G61468Medicare UPIN