Provider Demographics
NPI:1003806977
Name:DESHPANDE, SMITA V (MD)
Entity Type:Individual
Prefix:
First Name:SMITA
Middle Name:V
Last Name:DESHPANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 GLADES RD # SS 8W240
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6496
Mailing Address - Country:US
Mailing Address - Phone:561-297-3512
Mailing Address - Fax:561-297-0494
Practice Address - Street 1:777 GLADES RD # SS 8W240
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6424
Practice Address - Country:US
Practice Address - Phone:610-969-3390
Practice Address - Fax:610-969-3393
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME158311207Q00000X
PAMD039267L207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0050865000OtherIBC
PA0014630700004Medicaid
P002820OtherGATEWAY
464569OtherHIGHMARK BLUE SHIELD
03161201OtherCBC
PA0014630700004Medicaid
0050865000OtherIBC
PA080066096Medicare PIN