NPIMap

Organization Active NPI

Vasant Datta MD LLC

  • Primary Care Clinic/Center
  • Hagerstown, MD
National Provider Identifier
1790860898
Registry record updated Aug 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
D0018019 Issued in MD
Legal business name
VASANT DATTA MD LLC
Practice address
9727 Pembroke Dr
Hagerstown, MD 21740-1568
Phone
(240) 675-1231
Fax
(301) 714-0011
NPI assigned
Oct 26, 2006
Last updated
Aug 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2016

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

Authorized official

Name
Dr. Vasant Datta, M.D.NPI 1982666913
Title
M.D.
Phone
(301) 739-7100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X D0018019 MD Primary

Addresses

Primary practice location

9727 Pembroke Dr
Hagerstown, MD 21740-1568

Mailing address

340 Mill St
Hagerstown, MD 21740-6138
Phone (301) 739-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170228000757 MD Part B Supplier - Clinic/Group Practice 8820372469 Receives reassigned benefits from 1 practitioner
Practice locations: Hagerstown, MD
O20220719000138 WV Part B Supplier - Clinic/Group Practice 8820372469 Receives reassigned benefits from 1 practitioner
Practice locations: Charles Town, WV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471910400000",
    "number": "1790860898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 MILL ST",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406138",
            "telephone_number": "301-739-7100",
            "fax_number": "301-739-5925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9727 PEMBROKE DR",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217401568",
            "telephone_number": "240-675-1231",
            "fax_number": "301-714-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VASANT DATTA MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2016-08-23",
        "status": "A",
        "authorized_official_last_name": "DATTA",
        "authorized_official_first_name": "VASANT",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "301-739-7100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MD",
            "license": "D0018019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.