Provider Demographics
NPI:1457674327
Name:DEEP KUKRETI AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DEEP KUKRETI AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:KUKRETI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-776-4996
Mailing Address - Street 1:9900 WASHINGTON BLVD N
Mailing Address - Street 2:SUITE L
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1971
Mailing Address - Country:US
Mailing Address - Phone:301-776-4996
Mailing Address - Fax:301-483-8810
Practice Address - Street 1:9900 WASHINGTON BLVD N
Practice Address - Street 2:SUITE L
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1971
Practice Address - Country:US
Practice Address - Phone:301-776-4996
Practice Address - Fax:301-483-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052075208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1275507550Medicaid
MD1275507550Medicaid