Provider Demographics
NPI:1104642214
Name:DIAMOND STATE VASCULAR INTERVENTIONAL LLC
Entity type:Organization
Organization Name:DIAMOND STATE VASCULAR INTERVENTIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:
Authorized Official - First Name:NILOY
Authorized Official - Middle Name:
Authorized Official - Last Name:DASGUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-265-9715
Mailing Address - Street 1:9450 SW GEMINI DR STE 59742
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7105
Mailing Address - Country:US
Mailing Address - Phone:571-265-9715
Mailing Address - Fax:
Practice Address - Street 1:1941 LIMESTONE RD STE 15
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5423
Practice Address - Country:US
Practice Address - Phone:571-265-9715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty