Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD039267L | PA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD039267L | PA |
NPI | 1003806977 |
---|---|
Provider Name | Smita V Deshpande |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Allentown, PA 18102-3648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 10/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014630700004 | (05) | PA |
0050865000 | IBC (01) | |
03161201 | CBC (01) | |
464569 | HIGHMARK BLUE SHIELD (01) | |
E52826 | (02) | PA |
P002820 | GATEWAY (01) |