Provider Demographics
NPI:1447291539
Name:DESAI, SHIVRAJ JAGDISH (MD)
Entity type:Individual
Prefix:DR
First Name:SHIVRAJ
Middle Name:JAGDISH
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1501 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-2112
Mailing Address - Country:US
Mailing Address - Phone:610-520-1395
Mailing Address - Fax:610-520-1801
Practice Address - Street 1:1726 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2300
Practice Address - Country:US
Practice Address - Phone:215-463-5008
Practice Address - Fax:215-463-4223
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD031575E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE64145Medicare UPIN
PA068182Medicare ID - Type Unspecified