MEDICARE: DEEPA DHARMARAJAN M.D.

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
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	C173834	CA

General Provider Information

NPI Number	:	1770514531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPA DHARMARAJAN M.D.

Provider Business Mailing Address
First Line	:	8000 MARINA BLVD
Second Line	:	6TH FLOOR, SUITE 600
City	:	BRISBANE
State	:	CA
Zip	:	94005
Country	:	US
Telephone Number	:	415-514-3577
Fax Number	:	415-514-0702

Provider Business Practice Location Address
First Line	:	8000 MARINA BLVD
Second Line	:	6TH FLOOR, SUITE 600
City	:	BRISBANE
State	:	CA
Zip	:	94005
Country	:	US
Telephone Number	:	415-514-3577
Fax Number	:	415-514-0702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	01/13/2023

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