Provider Demographics
NPI:1144462896
Name:DALSANIA, HENRY JIVAN (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:JIVAN
Last Name:DALSANIA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:7600 WOLF RIVER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1788
Mailing Address - Country:US
Mailing Address - Phone:901-747-1007
Mailing Address - Fax:901-531-7199
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2113
Practice Address - Country:US
Practice Address - Phone:901-747-1000
Practice Address - Fax:901-747-1001
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2024-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS206852085R0204X, 2085R0202X
TN435972085R0204X, 2085R0202X
ARE-103732085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology