Provider Demographics
NPI:1952433062
Name:DUTTA, KAMAL KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:KUMAR
Last Name:DUTTA
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 1:426 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1534
Mailing Address - Country:US
Mailing Address - Phone:973-777-9889
Mailing Address - Fax:
Practice Address - Street 1:426 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1534
Practice Address - Country:US
Practice Address - Phone:973-777-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04150200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology