Provider Demographics
NPI:1245202696
Name:DESAI, NITIN DAHYABHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:NITIN
Middle Name:DAHYABHAI
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1309 MEDICAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4425
Mailing Address - Country:US
Mailing Address - Phone:910-437-5130
Mailing Address - Fax:910-437-5128
Practice Address - Street 1:1309 MEDICAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4425
Practice Address - Country:US
Practice Address - Phone:910-437-5130
Practice Address - Fax:910-437-5128
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 9600078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901515Medicaid
NCNC 9600078OtherLICENSE NO.
NCNC 9600078OtherLICENSE NO.
NCG21428Medicare UPIN
NC1245202696Medicare PIN