1275551061 NPI number — DR. RAHUL NAREN DESAI MD

Table of content: DR. RAHUL NAREN DESAI MD (NPI 1275551061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275551061 NPI number — DR. RAHUL NAREN DESAI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESAI
Provider First Name:
RAHUL
Provider Middle Name:
NAREN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275551061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
10/22/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8950 SW NIMBUS AVE
Provider Second Line Business Mailing Address:
150
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97008-7478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-535-8302
Provider Business Mailing Address Fax Number:
503-416-8732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8950 SW NIMBUS AVE
Provider Second Line Business Practice Location Address:
150
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97008-7478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-535-8302
Provider Business Practice Location Address Fax Number:
503-416-8732
Provider Enumeration Date:
07/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  35.083561 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)