| Your Visiting Doctor, Pllc | |
|
20325 N 51st Ave Bldg 6 Suite 142 Glendale AZ 85308-5674 | |
| (623) 587-4500 | |
| (602) 680-7576 |
| Full Name | Your Visiting Doctor, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 20325 N 51st Ave, Glendale, Arizona |
| Authorized Official Name and Position | Deepa Dharmarajan (OWNER) |
| Authorized Official Contact | 6239109730 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Visiting Doctor, Pllc Po Box 1149 Peoria AZ 85380-1149 Ph: (623) 910-9730 | Your Visiting Doctor, Pllc 20325 N 51st Ave Bldg 6 Suite 142 Glendale AZ 85308-5674 Ph: (623) 587-4500 |
| NPI Number | 1417118563 |
|---|---|
| Provider Enumeration Date | 06/20/2008 |
| Last Update Date | 07/15/2016 |
| Medicare PECOS PAC ID | 0749354223 |
|---|---|
| Medicare Enrollment ID | O20080731000623 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417118563 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | 35176 (Arizona) | Primary |
| Provider Name | Deepa Dharmarajan |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1770514531 PECOS PAC ID: 9032116652 Enrollment ID: I20061024000549 |
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