Provider Demographics
NPI:1174084115
Name:DESHAIES, DEREK MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:MICHAEL
Last Name:DESHAIES
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 855
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-0855
Mailing Address - Country:US
Mailing Address - Phone:724-223-3673
Mailing Address - Fax:724-229-2961
Practice Address - Street 1:88 WELLNESS WAY BLDG 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9720
Practice Address - Country:US
Practice Address - Phone:724-250-5293
Practice Address - Fax:724-579-1720
Is Sole Proprietor?:No
Enumeration Date:2019-03-30
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD485065208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery