Provider Demographics
NPI:1487848917
Name:ANANTHULA, DEEPTI (MD)
Entity Type:Individual
Prefix:
First Name:DEEPTI
Middle Name:
Last Name:ANANTHULA
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 1:1380 COWELL FARM RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3431
Mailing Address - Country:US
Mailing Address - Phone:215-361-4854
Mailing Address - Fax:
Practice Address - Street 1:1380 COWELL FARM RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3431
Practice Address - Country:US
Practice Address - Phone:215-361-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD441283OtherMEDICAL LICENSE