Provider Demographics
NPI:1750454161
Name:DESHPANDE, PRAMODINI S (MD)
Entity Type:Individual
Prefix:
First Name:PRAMODINI
Middle Name:S
Last Name:DESHPANDE
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 1:401 WEST THAMES STREET
Mailing Address - Street 2:SOUTHEASTERN MENTAL HEALTH AUTHORITY BLDG 301
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-859-4674
Mailing Address - Fax:860-859-4790
Practice Address - Street 1:401 WEST THAMES STREET
Practice Address - Street 2:SOUTHEASTERN MENTAL HEALTH AUTHORITY BLDG 301
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-859-4674
Practice Address - Fax:860-859-4790
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0226632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F18177Medicare UPIN