Provider Demographics
NPI:1326018821
Name:DESHPANDE, ABHIJIT G (MD)
Entity Type:Individual
Prefix:DR
First Name:ABHIJIT
Middle Name:G
Last Name:DESHPANDE
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 1:5219 W CLEARWATER AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1914
Mailing Address - Country:US
Mailing Address - Phone:509-873-0042
Mailing Address - Fax:509-873-0042
Practice Address - Street 1:34 MARK WEST SPRINGS RD FL 3
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1766
Practice Address - Country:US
Practice Address - Phone:707-573-5261
Practice Address - Fax:707-573-5414
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033867207R00000X, 207RS0012X, 207RA0401X
CAC143486207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA607333500OtherOWCP/ FECA
CAC143486OtherSTATE MEDICAL LICENSE
WAP00217647OtherRAILROAD MEDICARE
CA545019OtherABIM
WA1116938Medicaid
WAP00217647OtherRAILROAD MEDICARE
WA8856986Medicare PIN
WAP00217647OtherRAILROAD MEDICARE
WA5159730001Medicare NSC
WAG8882805Medicare PIN
WA2980DEOtherREGENCE KENNEWICK
WAGAB34029Medicare PIN