Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD00033867 | WA |
N | 111NI0900X | Internist | MD00033867 | WA |
N | 207RA0401X | Internist - Addiction Medicine | C143486 | CA |
Y | 207RA0401X | Internist - Addiction Medicine | MD00033867 | WA |
N | 207RS0012X | Sleep Medicine | MD00033867 | WA |
NPI | 1326018821 |
---|---|
Provider Name | Dr. Abhijit G Deshpande |
First Address | Kennewick, WA 99336-1914 |
Second Address | Santa Rosa, CA 95403-1766 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 19/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1116938 | (05) | WA |
545019 | ABIM (01) | CA |
607333500 | OWCP/ FECA (01) | WA |
C143486 | STATE MEDICAL LICENSE (01) | CA |
G39262 | (02) | WA |
P00217647 | RAILROAD MEDICARE (01) | WA |