Provider Demographics
NPI:1861473514
Name:PRUSTY, DEEPANWITA (MD PHD)
Entity type:Individual
Prefix:MS
First Name:DEEPANWITA
Middle Name:
Last Name:PRUSTY
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 MAIN ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1818
Mailing Address - Country:US
Mailing Address - Phone:392-014-0533
Mailing Address - Fax:781-871-3425
Practice Address - Street 1:544 MAIN ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1818
Practice Address - Country:US
Practice Address - Phone:339-201-4053
Practice Address - Fax:781-871-3425
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214928174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
459067OtherTUFTS AND TUFTS MEDICARE PREFERRED
MASS0074OtherBCBSMA
042297845OtherTRICARE
042297845OtherUNITED HEALTH CARE
MA1861473514OtherNEIGHBORHOOD HEALTH PLAN
042297845OtherGREAT WEST
042297845OtherMULTI-PLAN
1861473514OtherNHP
1861473514OtherFALLON
9355125OtherAETNA
042297845OtherGIC UNICARE
042297845OtherHCVM
AA193220OtherHARVARD PILGRIM
MA11078614AMedicaid
7541384OtherCIGNA
042297845OtherGIC UNICARE