Provider Demographics
NPI:1073511200
Name:DESHMUKH, PRAVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVIN
Middle Name:
Last Name:DESHMUKH
Suffix:
Gender:M
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:PO BOX 639970
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9970
Mailing Address - Country:US
Mailing Address - Phone:804-612-2980
Mailing Address - Fax:804-360-2437
Practice Address - Street 1:12320 W BROAD ST STE 204
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7603
Practice Address - Country:US
Practice Address - Phone:804-612-2980
Practice Address - Fax:804-360-2437
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV6397AMedicare PIN
TX8B6011Medicare ID - Type UnspecifiedMEDICARE NUMBER
TXI04476Medicare UPIN