Provider Demographics
NPI:1326012113
Name:DESAI, MAULIN MAHESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAULIN
Middle Name:MAHESH
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 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:804-217-7991
Practice Address - Street 1:3432 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BCH
Practice Address - State:VA
Practice Address - Zip Code:23452-4846
Practice Address - Country:US
Practice Address - Phone:757-468-1855
Practice Address - Fax:757-468-4441
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232624207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010094500Medicaid
VA010094500Medicaid
VA066184I88Medicare PIN
VA007184P95 - C03895Medicare PIN