Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MD039011E | PA |
NPI | 1053332627 |
---|---|
Provider Name | Dr. Jayesh B Desai |
First Address | Somerset, PA 15501-2271 |
Second Address | Somerset, PA 15501-2271 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 05/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001202673 | (05) | PA |
E55578 | (02) |