| Vasant Datta MD LLC | |
|
9727 Pembroke Dr Hagerstown MD 21740-1568 | |
| (240) 675-1231 | |
| (301) 714-0011 |
| Full Name | Vasant Datta MD LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 9727 Pembroke Dr, Hagerstown, Maryland |
| Authorized Official Name and Position | Vasant Datta (M.D.) |
| Authorized Official Contact | 3017397100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vasant Datta MD LLC 340 Mill St Hagerstown MD 21740-6138 Ph: (301) 739-7100 | Vasant Datta MD LLC 9727 Pembroke Dr Hagerstown MD 21740-1568 Ph: (240) 675-1231 |
| NPI Number | 1790860898 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 08/23/2016 |
| Medicare PECOS PAC ID | 8820372469 |
|---|---|
| Medicare Enrollment ID | O20170228000757 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790860898 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | D0018019 (Maryland) | Primary |
| Provider Name | Vasant Datta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982666913 PECOS PAC ID: 3971499070 Enrollment ID: I20101123001004 |
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