Provider Demographics
NPI:1063612737
Name:DATTA-THOMAS, MOUSHUMI SHOMA (MD)
Entity type:Individual
Prefix:DR
First Name:MOUSHUMI
Middle Name:SHOMA
Last Name:DATTA-THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MAIDEN LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4831
Mailing Address - Country:US
Mailing Address - Phone:646-290-9560
Mailing Address - Fax:
Practice Address - Street 1:90 MAIDEN LN
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4831
Practice Address - Country:US
Practice Address - Phone:646-290-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241323207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology