Healthcare Provider Details

I. General information

NPI: 1356578058
Provider Name (Legal Business Name): DILRAJ DEOL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD STE 100
BALTIMORE MD
21239-2946
US

IV. Provider business mailing address

827 LINDEN AVE 3E-F
BALTIMORE MD
21201-4606
US

V. Phone/Fax

Practice location:
  • Phone: 434-445-8354
  • Fax: 434-445-8364
Mailing address:
  • Phone: 410-225-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number33004
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD74556
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: