| Gaurav Datta MD Inc | |
|
7510 Fortaleza Ave Elk Grove CA 95757-1769 | |
| (414) 336-8677 | |
| (925) 954-6958 |
| Full Name | Gaurav Datta MD Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7510 Fortaleza Ave, Elk Grove, California |
| Authorized Official Name and Position | Gaurav Datta (OWNER) |
| Authorized Official Contact | 4143368677 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gaurav Datta MD Inc 7510 Fortaleza Ave Elk Grove CA 95757-1769 Ph: (414) 336-8677 | Gaurav Datta MD Inc 7510 Fortaleza Ave Elk Grove CA 95757-1769 Ph: (414) 336-8677 |
| NPI Number | 1033735931 |
|---|---|
| Provider Enumeration Date | 06/17/2020 |
| Last Update Date | 01/13/2023 |
| Certification Date | 01/13/2023 |
| Medicare PECOS PAC ID | 9234551920 |
|---|---|
| Medicare Enrollment ID | O20200625002405 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033735931 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| 282N00000X | General Acute Care Hospital | () | Secondary |
| Provider Name | Gaurav Datta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225184765 PECOS PAC ID: 7113093055 Enrollment ID: I20180822001727 |
| Provider Name | Bhupinder K Sangha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295137784 PECOS PAC ID: 7012225832 Enrollment ID: I20200316001468 |
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