Provider Demographics
NPI:1144621012
Name:GANDHIRAJ, DEEPTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPTHI
Middle Name:
Last Name:GANDHIRAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 STATE HIGHWAY 121 STE 1100
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6148
Mailing Address - Country:US
Mailing Address - Phone:281-468-9920
Mailing Address - Fax:
Practice Address - Street 1:981 STATE HIGHWAY 121 STE 1100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6148
Practice Address - Country:US
Practice Address - Phone:737-758-4049
Practice Address - Fax:888-905-2543
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT4365207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine