Provider Demographics
NPI:1730247727
Name:DATTA, PIYALI (MD)
Entity type:Individual
Prefix:DR
First Name:PIYALI
Middle Name:
Last Name:DATTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 HALL BLVD
Mailing Address - Street 2:3RD FL - POD B - CREDENTIALING
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002
Mailing Address - Country:US
Mailing Address - Phone:860-714-9333
Mailing Address - Fax:860-714-8602
Practice Address - Street 1:444 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1969
Practice Address - Country:US
Practice Address - Phone:413-598-7090
Practice Address - Fax:413-598-7040
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA231488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2143356Medicaid
MA2143356Medicaid