Provider Demographics
NPI:1841298387
Name:DASGUPTA, ANIRUDHA (MD)
Entity type:Individual
Prefix:
First Name:ANIRUDHA
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 1:22710 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6008
Mailing Address - Country:US
Mailing Address - Phone:281-298-8444
Mailing Address - Fax:
Practice Address - Street 1:22710 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6008
Practice Address - Country:US
Practice Address - Phone:281-298-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9245207RH0003X
LAMD.11861R207RH0003X
LA11861R207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283961501Medicaid
MS02332093Medicaid
LA1683230Medicaid
TX8K8933Medicare PIN
TX8K8932Medicare PIN
MS02332093Medicaid
LAG33803Medicare UPIN
TX283961501Medicaid
LA5W9887061Medicare PIN