Healthcare Provider Details

I. General information

NPI: 1609339050
Provider Name (Legal Business Name): VIPLAV NARAYAN DEOGAONKAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HOSPITAL RD STE 300
PRINCE FREDERICK MD
20678-4057
US

IV. Provider business mailing address

121 DEKALB AVE
BROOKLYN NY
11201-5493
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-4333
  • Fax: 410-535-3260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD92855
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: