1164432811 NPI number — SHIRISH DESAI, MD, INC

Table of content: (NPI 1164432811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164432811 NPI number — SHIRISH DESAI, MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIRISH DESAI, MD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1164432811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 MARY HIGGINSON LN
Provider Second Line Business Mailing Address:
LEVEL 1
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15401-2658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-438-8765
Provider Business Mailing Address Fax Number:
724-438-3911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 MARY HIGGINSON LN
Provider Second Line Business Practice Location Address:
LEVEL 1
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-438-8765
Provider Business Practice Location Address Fax Number:
724-438-3911
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DESAI
Authorized Official First Name:
SHIRISH
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
724-438-8765

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD-023993-E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MD-022718-E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MD-065657-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MD-031116-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MD-046651-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0660674 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0703379 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1716569 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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