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NPI Code Detail

MEDICARE: DR. DEEPIKA NAIDU THOTA

MEDICARE: DR. DEEPIKA NAIDU THOTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0700XProsthodontics0401418596VA

General Provider Information

NPI Number : 1093599284
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEEPIKA NAIDU THOTA
Provider Business Mailing Address
First Line : 1939 ROLAND CLARKE PL STE 120
Second Line :
City : RESTON
State : VA
Zip : 20191-1445
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1939 ROLAND CLARKE PL STE 120
Second Line :
City : RESTON
State : VA
Zip : 20191-1445
Country : US
Telephone Number : 571-616-9685
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2023
Last Update Date : 08/21/2023

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Directions to “ DR. DEEPIKA NAIDU THOTA ” Practice Location

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