=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821223835
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEEPAK K CHOPRA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2009
-----------------------------------------------------
Last Update Date | 05/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2013 COSTA DEL MAR RD
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92009-6801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-494-1625
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 TREMONT ST #201
-----------------------------------------------------
City | MELROSE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02176-2721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-494-1625
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 35163
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------