Sudip Datta, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

2012029909 Issued in MO

Practice address

639 Tanya Court Dr
Saint Louis, MO 63129-2555

Phone

(270) 804-8025

NPI assigned

Jun 2, 2009

Last updated

Aug 14, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dyersburg Clinic Corp

  • Family Medicine Physician
  • Dyersburg, TN
  • NPI 1093710568
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376438400000",
    "number": "1366678567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "639 TANYA COURT DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631292555",
            "telephone_number": "270-804-8025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 TANYA COURT DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631292555",
            "telephone_number": "270-804-8025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATTA",
        "first_name": "SUDIP",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-02",
        "last_updated": "2013-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "TP647",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "KY",
            "license": "TP647",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "2012029909",
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "KY",
            "license": "TP647",
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "MO",
            "license": "2012029909",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Dashnaw, MD
• Jessica Lynn Dashner, OT
• Joseph Francis Dasso, M.D, PH.D.
• Chloe Suzanne Datillo, NURSE PRACTITIONER
• Gautam Datta, M.D.
• Antara Dattagupta, MD, MENG
• Shiraz A Daud, M.D.
• Umar Daud, MD
• Yasmeen Naheed Daud, MD
• Marty Jean Dauer, L.P.C.

• Cardiovascular Disease Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Cardiovascular Disease Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.