Provider Demographics
NPI:1992752885
Name:DUTTA, TIMOTHY CHANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHANDRA
Last Name:DUTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4726
Mailing Address - Country:US
Mailing Address - Phone:212-249-3725
Mailing Address - Fax:212-249-4874
Practice Address - Street 1:310 E 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4726
Practice Address - Country:US
Practice Address - Phone:212-249-3725
Practice Address - Fax:212-249-4874
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219812207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI53818Medicare UPIN