Individual
VIVEKANAND DATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
8700 BEVERLY BLVD., CEDAR SINAI, LOS ANGELES, CA 90048
(310) 423-6941
Mailing address
11767 SKYLARK RD, CLARKSBURG, MD 20871
(901) 786-4755
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
390200000X
TN
Other
Enumeration date
04/26/2007
Last updated
07/13/2009
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