Healthcare Provider Details

I. General information

NPI: 1558572842
Provider Name (Legal Business Name): SUNDEEP DEORAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 STONY POINT DR
RICHMOND VA
23235
US

IV. Provider business mailing address

9101 STONY POINT DR
RICHMOND VA
23235
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-9105
  • Fax: 804-521-1061
Mailing address:
  • Phone: 804-330-9105
  • Fax: 804-521-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number39800
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number57011357
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101260400
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: