Provider Demographics
NPI:1699953117
Name:MONY, DEEPA PULLATHU (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:PULLATHU
Last Name:MONY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ELDEN ST STE 140
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4835
Mailing Address - Country:US
Mailing Address - Phone:703-263-9323
Mailing Address - Fax:703-263-0311
Practice Address - Street 1:131 ELDEN ST STE 140
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4835
Practice Address - Country:US
Practice Address - Phone:703-263-9323
Practice Address - Fax:703-263-0311
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243868208000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics