Provider Demographics
NPI:1356578058
Name:DEOL, DILRAJ
Entity type:Individual
Prefix:
First Name:DILRAJ
Middle Name:
Last Name:DEOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 LINDEN AVE
Mailing Address - Street 2:3E-F
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4606
Mailing Address - Country:US
Mailing Address - Phone:410-225-8404
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2946
Practice Address - Country:US
Practice Address - Phone:434-445-8354
Practice Address - Fax:434-445-8364
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33004174400000X
MDD74556207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist