Provider Demographics
NPI:1346506995
Name:DATTA, NEHA (MD)
Entity type:Individual
Prefix:DR
First Name:NEHA
Middle Name:
Last Name:DATTA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-7388
Mailing Address - Fax:833-301-0853
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV SURG PLASTICS, STE 6G
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-7388
Practice Address - Fax:833-301-0853
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023025214208600000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200126953Medicaid