Provider Demographics
NPI:1861483380
Name:DALAL, GEETA N (MD)
Entity Type:Individual
Prefix:DR
First Name:GEETA
Middle Name:N
Last Name:DALAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4540 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:STE C130
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6928
Mailing Address - Country:US
Mailing Address - Phone:337-993-1943
Mailing Address - Fax:337-993-1944
Practice Address - Street 1:4540 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:STE C130
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6928
Practice Address - Country:US
Practice Address - Phone:337-993-1943
Practice Address - Fax:337-993-1944
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAL7239R2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1365637Medicaid
LA1365637Medicaid