Provider Demographics
NPI:1992737787
Name:GUHA-THAKURTA, NANDITA (MD)
Entity type:Individual
Prefix:DR
First Name:NANDITA
Middle Name:
Last Name:GUHA-THAKURTA
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 1:9502 PEMBERTON TRCE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-3761
Mailing Address - Country:US
Mailing Address - Phone:713-432-1421
Mailing Address - Fax:
Practice Address - Street 1:1400 PRESSLER ST
Practice Address - Street 2:UNIT 1482, MD ANDERSON CENCER CENTER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3722
Practice Address - Country:US
Practice Address - Phone:713-792-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2242232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ28736OtherBCBS MA
MA468477OtherTUFTS HEALTH PLAN
MA2104903Medicaid
MA468477OtherTUFTS HEALTH PLAN
MAA38571Medicare ID - Type Unspecified