Provider Demographics
NPI:1043206998
Name:PINA, DESIDERIO (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DESIDERIO
Middle Name:
Last Name:PINA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 DAYTON XENIA RD STE 900-386
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6390
Mailing Address - Country:US
Mailing Address - Phone:937-244-9812
Mailing Address - Fax:
Practice Address - Street 1:2542 KING CHARLES ST
Practice Address - Street 2:SUITE: B
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-5719
Practice Address - Country:US
Practice Address - Phone:937-320-1880
Practice Address - Fax:937-320-1880
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2216112084P0800X
NY2116112084P0800X
PAMD4776182084P0800X
OH35-0835732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2447598Medicaid
OH2447598Medicaid