=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245240647
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRUDULA ABHAY DESHPANDE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 06/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13740 RESEARCH BLVD V-1
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78750-1884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-250-0406
-----------------------------------------------------
Fax | 512-250-0531
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10603 PICKFAIR DR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78750-4010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-250-0409
-----------------------------------------------------
Fax | 512-250-0666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | G8078
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------