Provider Demographics
NPI:1770076465
Name:DALAL, SARTHI (DO)
Entity type:Individual
Prefix:
First Name:SARTHI
Middle Name:
Last Name:DALAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-2126
Mailing Address - Country:US
Mailing Address - Phone:610-613-1504
Mailing Address - Fax:215-935-4906
Practice Address - Street 1:4131 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127-2126
Practice Address - Country:US
Practice Address - Phone:610-613-1504
Practice Address - Fax:215-935-4906
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS020820208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1038263750001Medicaid