Provider Demographics
NPI:1548417488
Name:VILAS DESHPANDE M.D., PA
Entity Type:Organization
Organization Name:VILAS DESHPANDE M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VILAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHPANDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-528-0815
Mailing Address - Street 1:5880 49TH ST N
Mailing Address - Street 2:SUITE 101-N
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2150
Mailing Address - Country:US
Mailing Address - Phone:727-528-0815
Mailing Address - Fax:727-528-1724
Practice Address - Street 1:5880 49TH ST N
Practice Address - Street 2:SUITE 101-N
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2150
Practice Address - Country:US
Practice Address - Phone:727-528-0815
Practice Address - Fax:727-528-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050528174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250630100Medicaid
FL28975Medicare PIN
FL250630100Medicaid