Provider Demographics
NPI:1134113285
Name:DESAI, PARIMAL C (MD)
Entity Type:Individual
Prefix:
First Name:PARIMAL
Middle Name:C
Last Name:DESAI
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 1:9001 DIGGES RD
Mailing Address - Street 2:STE 105
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4414
Mailing Address - Country:US
Mailing Address - Phone:703-369-5000
Mailing Address - Fax:703-369-5003
Practice Address - Street 1:9001 DIGGES RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4421
Practice Address - Country:US
Practice Address - Phone:703-369-5000
Practice Address - Fax:703-369-5003
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA05622832Medicaid
080175697OtherRR MEDICARE
080175697OtherRR MEDICARE
VA080007763Medicare PIN