Provider Demographics
NPI:1326407784
Name:BABU, DEENA (PA)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:BABU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEENA
Other - Middle Name:
Other - Last Name:ZACHARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:13225 COPLAND CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 IRVING ST NW STE 301
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-877-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-14
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019209363A00000X
DCPA031673363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant