Provider Demographics
NPI:1457312654
Name:DESAI, SWETA A (MD)
Entity Type:Individual
Prefix:
First Name:SWETA
Middle Name:A
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:275 VARNUM AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2109
Mailing Address - Country:US
Mailing Address - Phone:978-934-9220
Mailing Address - Fax:978-453-7771
Practice Address - Street 1:275 VARNUM AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2109
Practice Address - Country:US
Practice Address - Phone:978-934-9220
Practice Address - Fax:978-453-7771
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA239543207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082523AMedicaid
MAI23634Medicare UPIN
MA001087001Medicare PIN