Healthcare Provider Details

I. General information

NPI: 1972940450
Provider Name (Legal Business Name): DEEPA RAMANATHAN ELION PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEEPA RAMANATHAN PH.D.

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RICHMOND VA MEDICAL CENTER 1201 BROADROCK BLVD
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

5461 MARLSTONE LN
FAIRFAX VA
22030-5834
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810005283
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005283
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: