Provider Demographics
NPI:1801902283
Name:DALAL, PIYUSH (MD)
Entity type:Individual
Prefix:
First Name:PIYUSH
Middle Name:
Last Name:DALAL
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 1:7047 66TH ST
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-4002
Mailing Address - Country:US
Mailing Address - Phone:727-545-8887
Mailing Address - Fax:
Practice Address - Street 1:3701 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1313
Practice Address - Country:US
Practice Address - Phone:727-896-1515
Practice Address - Fax:727-896-2182
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110199969OtherRAILROAD MEDICARE INDIVID
FL269324100Medicaid
FLCC1712OtherRAILROAD MEDICARE GROUP
FL33974BMedicare PIN
FL31689WMedicare PIN
FLG36524Medicare UPIN
FL33974CMedicare PIN
FL31689YMedicare PIN
FL110199969OtherRAILROAD MEDICARE INDIVID
FL269324100Medicaid
FL33974AMedicare PIN