Healthcare Provider Details

I. General information

NPI: 1639329550
Provider Name (Legal Business Name): DEEPA KATTAIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2008
Last Update Date: 04/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS STREET ROOM 6349H
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

1800 ORLEANS STREET ROOM 6349H
BALTIMORE MD
21287-0010
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-3865
  • Fax:
Mailing address:
  • Phone: 410-955-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD74805
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberD74805
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD74805
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: