Provider Demographics
NPI:1154308369
Name:DEEP, NINA (MD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:DEEP
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 1:5150 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8701
Mailing Address - Country:US
Mailing Address - Phone:614-855-5555
Mailing Address - Fax:
Practice Address - Street 1:5150 E DUBLIN GRANVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8701
Practice Address - Country:US
Practice Address - Phone:614-855-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-9940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2045209Medicaid
OH2045209Medicaid