Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101232624 | VA |
N | 207QS0010X | Family Doctor - Sports Medicine | 0101232624 | VA |
NPI | 1326012113 |
---|---|
Provider Name | Dr. Maulin Mahesh Desai |
First Address | Glen Allen, VA 23060-9263 |
Second Address | Virginia Bch, VA 23452-4846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010094500 | (05) | VA |
I22810 | (02) | VA |