Provider Demographics
NPI:1336206291
Name:MENON, DEEPA UNNIKRISHNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:UNNIKRISHNAN
Last Name:MENON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEEPA
Other - Middle Name:
Other - Last Name:UNNIKRISHNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3712 GREEN OAK CT
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4259
Mailing Address - Country:US
Mailing Address - Phone:443-923-7582
Mailing Address - Fax:443-923-7560
Practice Address - Street 1:3901 GREENSPRING AVE
Practice Address - Street 2:KENNEDY KRIEGER INSTITUTE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1353
Practice Address - Country:US
Practice Address - Phone:443-923-7582
Practice Address - Fax:443-923-7560
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00606912080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities