Provider Demographics
NPI:1750460630
Name:VIJAY, DEEPA (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:
Last Name:VIJAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEEPA
Other - Middle Name:MYSORE
Other - Last Name:NARASIMHAMURTHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS
Mailing Address - Street 1:3124 BLUE RIDGE ROAD ST 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612
Mailing Address - Country:US
Mailing Address - Phone:919-782-0021
Mailing Address - Fax:919-571-0825
Practice Address - Street 1:3124 BLUE RIDGE ROAD ST 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612
Practice Address - Country:US
Practice Address - Phone:919-782-0021
Practice Address - Fax:919-571-0825
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901070208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC117184OtherWELLPATH
NC1239LOtherBCBS OF NC
NC1255658OtherUNITED HEALTHCARE
NC891239LMedicaid
NC92058OtherMEDCOST
NC7619341OtherAETNA
NC7399901OtherCIGNA