Basic Information
| Provider Information | |||||||||
| NPI: | 1508049388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAS | ||||||||
| FirstName: | SAMRAT | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| OtherLastName: | DAS | ||||||||
| OtherFirstName: | SAMRAT | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1701 W CHARLESTON BLVD | ||||||||
| Address2: | STE 670 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026712355 | ||||||||
| FaxNumber: | 7023825388 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 W CHARLESTON BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029926868 | ||||||||
| FaxNumber: | 7029926860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2007 | ||||||||
| LastUpdateDate: | 09/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 12539 | NV | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1508049388 | 05 | NV | MEDICAID |