Basic Information
| Provider Information | |||||||||
| NPI: | 1275731689 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAS | ||||||||
| FirstName: | NILADRI | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DAS | ||||||||
| OtherFirstName: | NIL | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 448 | ||||||||
| Address2: | |||||||||
| City: | EAST PETERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175200448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173917092 | ||||||||
| FaxNumber: | 7177352069 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 N 6TH ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196013096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102084559 | ||||||||
| FaxNumber: | 6104042240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 05/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD442875 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.