Provider Demographics
NPI:1720115280
Name:FOXHALL, DEEPTHI REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPTHI
Middle Name:REDDY
Last Name:FOXHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:DEEPTHI
Other - Middle Name:SHANKARA
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2230 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1230
Mailing Address - Country:US
Mailing Address - Phone:215-685-3808
Mailing Address - Fax:215-685-3848
Practice Address - Street 1:2230 COTTMAN AVE
Practice Address - Street 2:HEALTH CENTER # 10
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1230
Practice Address - Country:US
Practice Address - Phone:215-685-0604
Practice Address - Fax:215-685-0641
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117430EVHMedicare PIN