Provider Demographics
NPI:1649217464
Name:TIWARRI, DEEPNARAYAN (MD)
Entity Type:Individual
Prefix:
First Name:DEEPNARAYAN
Middle Name:
Last Name:TIWARRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8926 WOODYARD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4220
Mailing Address - Country:US
Mailing Address - Phone:301-868-7911
Mailing Address - Fax:301-868-2285
Practice Address - Street 1:8926 WOODYARD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4220
Practice Address - Country:US
Practice Address - Phone:301-868-7911
Practice Address - Fax:301-868-2285
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059942207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
61987202OtherBC/BS OF MD - GREENBELT
DCB6480005OtherBC/BS OF DC
DC038001300Medicaid
3117681OtherMAMSI
496582OtherHEALTHLINK
61987203OtherBC/BS MD - CLINTON
DC02810006OtherBC/BS OF DC
100954OtherPRIORITY PARTNERS
MD501927300Medicaid
7357049OtherAETNA HMO
7357049OtherAETNA PPO
58549OtherAMERICAID
H37391OtherUNITED HEALTHCARE
6946966OtherCIGNA
7357049OtherAETNA MNG
3117681OtherALLIANCE
100954OtherPRIORITY PARTNERS
496582OtherHEALTHLINK
012091 O50Medicare ID - Type Unspecified
P00156176Medicare PIN