Basic Information
| Provider Information | |||||||||
| NPI: | 1538378195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAI | ||||||||
| FirstName: | DEEPA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 EXECUTIVE CENTER PKWY | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224013100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407350560 | ||||||||
| FaxNumber: | 5407350567 | ||||||||
| Practice Location | |||||||||
| Address1: | 422 GARRISONVILLE RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | STAFFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225541573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406574800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101247874 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1538378195 | 05 | VA | MEDICAID |