Provider Demographics
NPI:1376503276
Name:DESAI, NAYAN (MD)
Entity Type:Individual
Prefix:
First Name:NAYAN
Middle Name:
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 1:800 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615
Mailing Address - Country:US
Mailing Address - Phone:864-234-5800
Mailing Address - Fax:864-284-0844
Practice Address - Street 1:800 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3300
Practice Address - Country:US
Practice Address - Phone:864-234-5800
Practice Address - Fax:864-284-0844
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD99391Medicare UPIN
SC82154Medicare ID - Type Unspecified
SCD993913641Medicare UPIN