Provider Demographics
NPI:1770514531
Name:DHARMARAJAN, DEEPA (MD)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:DHARMARAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 MARINA BLVD
Mailing Address - Street 2:6TH FLOOR, SUITE 600
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005
Mailing Address - Country:US
Mailing Address - Phone:415-514-3577
Mailing Address - Fax:415-514-0702
Practice Address - Street 1:8000 MARINA BLVD
Practice Address - Street 2:6TH FLOOR, SUITE 600
Practice Address - City:BRISBANE
Practice Address - State:CA
Practice Address - Zip Code:94005
Practice Address - Country:US
Practice Address - Phone:415-514-3577
Practice Address - Fax:415-514-0702
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC173834207QG0300X
AZ35176207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine