1336206291 NPI number — DR. DEEPA UNNIKRISHNAN MENON M.D.

Table of content: DR. DEEPA UNNIKRISHNAN MENON M.D. (NPI 1336206291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336206291 NPI number — DR. DEEPA UNNIKRISHNAN MENON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENON
Provider First Name:
DEEPA
Provider Middle Name:
UNNIKRISHNAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
UNNIKRISHNAN
Provider Other First Name:
DEEPA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336206291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3712 GREEN OAK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21234-4259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-923-7582
Provider Business Mailing Address Fax Number:
443-923-7560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 GREENSPRING AVE
Provider Second Line Business Practice Location Address:
KENNEDY KRIEGER INSTITUTE
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21211-1353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-923-7582
Provider Business Practice Location Address Fax Number:
443-923-7560
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0008X , with the licence number:  D0060691 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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