Individual
MR. VASANT DATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
340 MILL ST, HAGERSTOWN, MD 21740-6138
(301) 739-7100
(301) 739-5925
Mailing address
PO BOX 599, FUNKSTOWN, MD 21734-0599
(301) 739-7100
(301) 739-5925
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0018019
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41251801
BC/BC
MD
01
—
876319
MAMSI
MD
Enumeration date
04/05/2006
Last updated
07/09/2007
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