Individual
DR. ELLEN JOY DUTTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
LAHEY HOSPITAL AND MEDICAL CENTER, 41 MALL ROAD, BURLINGTON, MA 01805
(781) 744-8000
Mailing address
LAHEY PROVIDER ENROLLMENT, 41 MALL ROAD, BURLINGTON, MA 01805-0001
(781) 744-8085
(781) 744-5433
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
234028
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0090HU
BLUE CROSS BLUE SHIELD
TX
01
—
00927F
MEDICARE ID
TX
01
—
1829996 1
CIGNA PAL
TX
01
—
1829996 1
CIGNA PAL
—
01
—
4218788
BLUE LINK
TX
01
—
7543296
AETNA
TX
Enumeration date
07/03/2006
Last updated
12/06/2019
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