Mohamed R. Dattu, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD421369 Issued in PA

Practice address

600 Haverford Rd Ste 201
Haverford, PA 19041-1139

Phone

(717) 775-6189

Fax

(844) 726-8901

NPI assigned

Jul 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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

• Psychology & Counseling Associates, PC

  • Clinical Psychologist
  • Pottstown, PA
  • NPI 1750303368

  PA

  Medicare reassignment NPD
• Springfield Psychological PC

  • Mental Health Counselor
  • Springfield, PA
  • NPI 1295705317
  NPD

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1821028119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 HAVERFORD RD",
            "address_2": "SUITE 201",
            "city": "HAVERFORD",
            "state": "PA",
            "postal_code": "19041",
            "telephone_number": "724-288-4007",
            "fax_number": "412-206-0128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 HAVERFORD RD STE 201",
            "city": "HAVERFORD",
            "state": "PA",
            "postal_code": "190411139",
            "telephone_number": "717-775-6189",
            "fax_number": "844-726-8901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1370 Washington Pike",
            "address_2": "Suite 303",
            "address_purpose": "LOCATION",
            "city": "Bridgeville",
            "state": "PA",
            "postal_code": "150172862",
            "country_code": "US",
            "telephone_number": "412-206-0123",
            "fax_number": "412-206-0128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DATTU",
        "first_name": "MOHAMED",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD421369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "1588952",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karmen Lisa Copes, LCSW
• Nicole Beth Courtney, ATC
• Melissa Ann Cruice, ATC, CSCS
• Angela D'Angelis, M.S. CCC-SLP
• Chizarra Lateefah Dashiell
• David a. Reilly, D.M.D., P.C.
• Lauren Davis, MA, LPC
• Elena T Delbusto, M.D.
• Lucille Renee Derose, PTA
• Meghan Devries, PSYD

• All providers in Haverford, PA
• Psychiatry Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.