Provider Demographics
NPI:1356653653
Name:BHANSALI, DEEPTY (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPTY
Middle Name:
Last Name:BHANSALI
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 1:10218 SHINING WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5462
Mailing Address - Country:US
Mailing Address - Phone:415-474-7525
Mailing Address - Fax:
Practice Address - Street 1:10218 SHINING WILLOW DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5462
Practice Address - Country:US
Practice Address - Phone:415-474-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0079883207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology