Provider Demographics
NPI:1902394034
Name:DATTA, ROHAN (DO)
Entity type:Individual
Prefix:
First Name:ROHAN
Middle Name:
Last Name:DATTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250267
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0267
Mailing Address - Country:US
Mailing Address - Phone:617-835-7944
Mailing Address - Fax:
Practice Address - Street 1:511 W FM 544 STE 100
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4630
Practice Address - Country:US
Practice Address - Phone:214-294-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
TXU6941207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty