DR. DURBA DUTTA MD NPI 1053342212

NPI Information

NPI: 1053342212
Provider Name: DR. DURBA DUTTA, MD
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Organization: MODESTO RADIOLOGICAL MEDICAL GROUP INC

PECOS Registration: Yes

Address:
3883 AIRWAY DR STE 100
SANTA ROSA, CA
ZIP 95403
Phone: (707) 521-4480
Get Directions

DR. Durba Dutta, MD is a diagnostic radiology radiology in Santa Rosa, CA with 32 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. DR. Durba Dutta, MD NPI is 1053342212. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF MISSOURI, KANSAS CITY, SCHOOL OF MEDICINE
Graduation Year:1992

The provider's business location address is:

3883 AIRWAY DR STE 100
SANTA ROSA, CA
ZIP 95403
Phone: (707) 521-4480
Fax: (707) 521-4460

The NPI 1053342212 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/6/2006 and was last updated on 7/12/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology	RHL00161349	CALIFORNIA	Yes
2	208D00000X	General Practice		G87087	CALIFORNIA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	RHL00161349	OTHER	CALIFORNIA	CALIFORNIA XRAY BOARD
2	FD5608813	OTHER	CALIFORNIA	FEDERAL DEA LICENSE
3	3845061	OTHER		CIGNA
4	G87087	OTHER	CALIFORNIA	STATE MEDICAL LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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