Provider Demographics
NPI:1942468905
Name:RAWAT, DEEPTA VASUDEV (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPTA
Middle Name:VASUDEV
Last Name:RAWAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEEPTA
Other - Middle Name:VANI
Other - Last Name:VASUDEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:301 S 320TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5200
Mailing Address - Country:US
Mailing Address - Phone:253-874-7000
Mailing Address - Fax:
Practice Address - Street 1:301 S 320TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5200
Practice Address - Country:US
Practice Address - Phone:253-874-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442769174400000X, 207W00000X
CAA108827207W00000X
WAMD60481518207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025976340001Medicaid
PA1025976340001Medicaid