Basic Information
| Provider Information | |||||||||
| NPI: | 1518559236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEEPTHI S CULL MD PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AVANT-GARDE MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4225 LINCOLNSHIRE DR STE B | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628642157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182422317 | ||||||||
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| Practice Location | |||||||||
| Address1: | 116 EDDIE DOWLING HWY | ||||||||
| Address2: | |||||||||
| City: | NORTH SMITHFIELD | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028967327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017692200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2021 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | CULL | ||||||||
| AuthorizedOfficialFirstName: | DEEPTHI | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8477670137 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 208100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.