Healthcare Provider Details

I. General information

NPI: 1093777948
Provider Name (Legal Business Name): DEEPA LIMAYE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MOUNTAIN RD
FARMINGTON CT
06032-2479
US

IV. Provider business mailing address

200 MOUNTAIN RD
FARMINGTON CT
06032-2479
US

V. Phone/Fax

Practice location:
  • Phone: 860-676-9000
  • Fax: 860-676-1541
Mailing address:
  • Phone: 860-676-9000
  • Fax: 860-676-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number037231
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: