Provider Demographics
NPI:1164432811
Name:SHIRISH DESAI, MD, INC
Entity Type:Organization
Organization Name:SHIRISH DESAI, MD, INC
Other - Org Name:DESAI, RAYAN, AND CARDENAS UROLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRISH
Authorized Official - Middle Name:B
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-438-8765
Mailing Address - Street 1:205 MARY HIGGINSON LN
Mailing Address - Street 2:LEVEL 1
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-2658
Mailing Address - Country:US
Mailing Address - Phone:724-438-8765
Mailing Address - Fax:724-438-3911
Practice Address - Street 1:205 MARY HIGGINSON LN
Practice Address - Street 2:LEVEL 1
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2658
Practice Address - Country:US
Practice Address - Phone:724-438-8765
Practice Address - Fax:724-438-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-023993-E174400000X
PAMD-022718-E174400000X
PAMD-065657-L174400000X
PAMD-031116-L174400000X
PAMD-046651-L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0660674Medicaid
PA0703379Medicaid
PA1716569Medicaid
PA0660674Medicaid
PAG83268Medicare UPIN
PAF207959Medicare UPIN
PA161629Medicare ID - Type UnspecifiedMEDICARE
PAB36362Medicare UPIN