Provider Demographics
NPI:1134101934
Name:DESHPANDE, MOHAN SAKHARAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:SAKHARAM
Last Name:DESHPANDE
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 1:806 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3148
Mailing Address - Country:US
Mailing Address - Phone:201-997-8806
Mailing Address - Fax:
Practice Address - Street 1:806 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3148
Practice Address - Country:US
Practice Address - Phone:201-997-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA032698207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55228Medicare UPIN
NJ451609Medicare ID - Type Unspecified