1831718972 NPI number — MRS. DEEPA ABHILASH CRNP

Table of content: MRS. DEEPA ABHILASH CRNP (NPI 1831718972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831718972 NPI number — MRS. DEEPA ABHILASH CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABHILASH
Provider First Name:
DEEPA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1831718972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 CASTLEBAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-2604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-263-4729
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-5020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-341-3420
Provider Business Practice Location Address Fax Number:
410-341-3397
Provider Enumeration Date:
04/09/2020

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: 363LP0808X , with the licence number:  R176640 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: LG-0001421 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: LG-0001421 . This is a "FAMILY NURSE PREACTIONER LICENSE NO:" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: R176640 . This is a "CRNP-PMH LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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