Provider Demographics
NPI:1992093355
Name:MOOLA, DEEPTHI (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPTHI
Middle Name:
Last Name:MOOLA
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 1:1005 NORTH GLEBE RD
Mailing Address - Street 2:#430
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201
Mailing Address - Country:US
Mailing Address - Phone:571-302-3920
Mailing Address - Fax:571-302-3921
Practice Address - Street 1:1005 NORTH GLEBE RD
Practice Address - Street 2:#430
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201
Practice Address - Country:US
Practice Address - Phone:571-302-3920
Practice Address - Fax:571-302-3920
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258379207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program