Basic Information
Provider Information | |||||||||
NPI: | 1649585159 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DALSETH | ||||||||
FirstName: | NATASHA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KIRYANKOVA | ||||||||
OtherFirstName: | NATASHA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2450 W HUNTING PARK AVE | ||||||||
Address2: |   | ||||||||
City: | PHILADELPHIA | ||||||||
State: | PA | ||||||||
PostalCode: | 191291302 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2157078496 | ||||||||
FaxNumber: | 2157074086 | ||||||||
Practice Location | |||||||||
Address1: | 100 E LEHIGH AVE | ||||||||
Address2: |   | ||||||||
City: | PHILADELPHIA | ||||||||
State: | PA | ||||||||
PostalCode: | 191251012 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2157078496 | ||||||||
FaxNumber: | 2157074086 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/10/2010 | ||||||||
LastUpdateDate: | 04/20/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MT197900 | PA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 103T00000X | MD451336 | PA | Y |   | Behavioral Health & Social Service Providers | Psychologist |   |
No ID Information.