Basic Information
| Provider Information | |||||||||
| NPI: | 1912284654 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAPASH DAS MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 S 4TH AVE STE 108A | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853647234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283179100 | ||||||||
| FaxNumber: | 9293179300 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 S AVENUE A | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853647127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283179100 | ||||||||
| FaxNumber: | 9283179300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2011 | ||||||||
| LastUpdateDate: | 11/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | DAS | ||||||||
| AuthorizedOfficialFirstName: | TAPASH | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9283179100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 33014 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 868599 | 05 | AZ | MEDICAID |