Provider Demographics
NPI:1477502532
Name:DESAI, BHARATI P (MD)
Entity Type:Individual
Prefix:
First Name:BHARATI
Middle Name:P
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRADDOCK ROAD AVE
Mailing Address - Street 2:HUNTINGDON PLACE
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1458
Mailing Address - Country:US
Mailing Address - Phone:724-547-4547
Mailing Address - Fax:724-547-7460
Practice Address - Street 1:1 BRADDOCK ROAD AVE
Practice Address - Street 2:HUNTINGDON PLACE
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1458
Practice Address - Country:US
Practice Address - Phone:724-547-4547
Practice Address - Fax:724-547-7460
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021441E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006396160001Medicaid
PA0006396160001Medicaid