Provider Demographics
NPI:1922030477
Name:DATTA, ANANDITA ASHOKE (MD)
Entity type:Individual
Prefix:
First Name:ANANDITA
Middle Name:ASHOKE
Last Name:DATTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 TESLA DR STE H
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4327
Mailing Address - Country:US
Mailing Address - Phone:301-464-0603
Mailing Address - Fax:
Practice Address - Street 1:4801 TESLA DR STE H
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4327
Practice Address - Country:US
Practice Address - Phone:301-464-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036064207ZP0102X
NC2005-00431207ZP0102X
MDD70018207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF830JM - 96812203OtherCAREFIRST
MD7795VA - 96812202OtherCAREFIRST
MD5184GE - 96812201OtherCAREFIRST
DC7592 - 0003OtherCAREFIRST
MD132796 - 191662ZAYCOtherMEDICARE
DCW247 - 0003OtherCAREFIRST
MD7797 - 191662YB8OtherMEDICARE
MD5184 - 191662YB84OtherMEDICARE
DCN358 - 0003OtherCAREFIRST