Provider Demographics
NPI:1043898331
Name:VEDERE, DEEPTI (MD)
Entity type:Individual
Prefix:
First Name:DEEPTI
Middle Name:
Last Name:VEDERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEEPTI
Other - Middle Name:SHANBHAG
Other - Last Name:VEDERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:475 S COLUMBIA RIVER HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-2860
Mailing Address - Country:US
Mailing Address - Phone:503-397-0471
Mailing Address - Fax:
Practice Address - Street 1:475 S COLUMBIA RIVER HWY STE 100
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2860
Practice Address - Country:US
Practice Address - Phone:503-397-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD219116207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine