Provider Demographics
NPI:1811017957
Name:DASGUPTA, DEBASIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBASIS
Middle Name:
Last Name:DASGUPTA
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 1:12200 PARK CENTRAL DR
Mailing Address - Street 2:SUITE 189
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2100
Mailing Address - Country:US
Mailing Address - Phone:972-503-5300
Mailing Address - Fax:972-503-5301
Practice Address - Street 1:12200 PARK CENTRAL DR
Practice Address - Street 2:SUITE 189
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2100
Practice Address - Country:US
Practice Address - Phone:972-503-5300
Practice Address - Fax:972-503-5301
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8E0291Medicare ID - Type Unspecified
I21188Medicare UPIN