Application for Renewal Of Registration   with the
Maharashtra Medical Council, Mumbai
Application No :  MMC202239265 Date : 16/02/2022
To,
Registrar ,
Maharashtra Medical Council ,
189/A, Anand Complex, 2nd Floor,
Sane Guruji Marg, Arthur Road Naka,
Chinchpokali (W), Mumbai - 400 011.
 
Sub: Dr  (Smt/Shri)  NAGAVEKAR DEEPALI VILAS
Registration No:  2000093142   Registration Date : 04/09/2000   Valid upto Date :28/02/2027
Sir,
I the undersigned applicant, request yoy that my name may be continued on the Register of Medical Practitioners maintained by the Maharashtra Medical Council as per 23 (a)/23 (c) of MMC Act 1965 and amendment 2003. My particulars are as Follows :
Name of Applicant : Ms. NAGAVEKAR DEEPALI VILAS
Name of Father : Mr.
Name of Mother : Mrs.
In Case of Married Women
Maiden Name : -

RESEDENTIAL ADDRESS : 195, NANDANVAN, SECTOR-17, LANE 5, NERUL, NAVI MUMBAI
City : NAVI MUMBAI District : THANE
State : MAHARASHTRA Country : INDIA
Pincode : 400706
Date of birth : 21/02/1977 Tel No (Res) : 77188960672 Clinic No :
Mobile No : 9819180937 Email Id : deepalioncall77@gmail.com  
Total Obtained Credits Points : 52
Remaining Credits Points : 0
Qualification Details
 Details of QualificationName of CollegeUniversityPassing YearCertificate NoCertificate Date
1.M.B.B.S.MGMMC, NAVI MUMBAIMUMBAI UNIVERSITY2000  
2.M.D.(Anaesthesiology)MGMMC, NAVI MUMBAIMUMBAI UNIVERSITY20042452524/04/2006
Pariticulars Of Payment
Payment Mode : Online Payment
Receipt No : 202204710031321
Receipt Date : 18/02/2022
   I have uploaded following documents:
1.Latest Passport size Photograph
DECLARATION (Registered Medical Practitioner)
I shall abide by the Code of medical Ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002.
Date : 16/02/2022
    Applicant signature               


NOTE:- You do not need to submit the print out of original submitted Renewal Application form to MMC office.