Provider Demographics
NPI:1154580249
Name:THOPPIL, DEEPU RAPHAEL (MD)
Entity type:Individual
Prefix:
First Name:DEEPU
Middle Name:RAPHAEL
Last Name:THOPPIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MERIT HEALTH MEDICAL GROUP-PULMONOLOGY
Mailing Address - Street 2:200 W HOSPITAL DRIVE
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402
Mailing Address - Country:US
Mailing Address - Phone:601-296-3000
Mailing Address - Fax:601-296-3001
Practice Address - Street 1:MERIT HEALTH MEDICAL GROUP-PULMONOLOGY
Practice Address - Street 2:200 W HOSPITAL DRIVE
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-296-3000
Practice Address - Fax:601-296-3001
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24167207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03603097Medicaid
MS489974YKD8OtherMEDICARE-B