Provider Demographics
NPI:1679734412
Name:DATTA, HARSH (MD)
Entity type:Individual
Prefix:
First Name:HARSH
Middle Name:
Last Name:DATTA
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 1:15204 SPOTTED TURTLE CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5876
Mailing Address - Country:US
Mailing Address - Phone:703-625-9213
Mailing Address - Fax:
Practice Address - Street 1:15204 SPOTTED TURTLE CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5876
Practice Address - Country:US
Practice Address - Phone:703-625-9213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA107076002080N0001X
MDD00736072080N0001X
VA01012429832080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine