Provider Demographics
NPI:1023266350
Name:DATTA, SUBODH K (MD)
Entity type:Individual
Prefix:
First Name:SUBODH
Middle Name:K
Last Name:DATTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 TARRYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1424
Mailing Address - Country:US
Mailing Address - Phone:914-989-7600
Mailing Address - Fax:914-285-4991
Practice Address - Street 1:330 TARRYTOWN RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1424
Practice Address - Country:US
Practice Address - Phone:914-989-7600
Practice Address - Fax:914-285-4991
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY249521207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology