MEDICARE: DR. MONAL DEPANI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1659075737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONAL DEPANI MD

Provider Business Mailing Address
First Line	:	6017 BUR TRL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-5455
Country	:	US
Telephone Number	:	910-977-9510
Fax Number	:

Provider Business Practice Location Address
First Line	:	6017 BUR TRL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-5455
Country	:	US
Telephone Number	:	910-977-9510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	03/30/2023

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