Provider Demographics
NPI:1194938035
Name:DASGUPTA, ANJALI (MD)
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:DASGUPTA
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 1:508 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2808
Mailing Address - Country:US
Mailing Address - Phone:936-523-1701
Mailing Address - Fax:936-523-1706
Practice Address - Street 1:508 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2808
Practice Address - Country:US
Practice Address - Phone:936-523-1701
Practice Address - Fax:936-523-1706
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9950207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094010801OtherGROUP MEDICAID NUMBER
TX00J21AOtherGROUP MEDICARE NUMBER