Provider Demographics
NPI:1629185848
Name:DESAI, MEENA (MD)
Entity Type:Individual
Prefix:
First Name:MEENA
Middle Name:
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 1:29 DEPOT STREET
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2323
Mailing Address - Country:US
Mailing Address - Phone:570-383-7233
Mailing Address - Fax:570-489-2802
Practice Address - Street 1:29 DEPOT STREET
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2323
Practice Address - Country:US
Practice Address - Phone:570-383-7233
Practice Address - Fax:570-489-2802
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027269-E207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009377430004Medicaid
PA900097656OtherRAILROAD MEDICARE
PA443363OtherBLUE SHIELD
C34224Medicare UPIN
PA443363Medicare ID - Type Unspecified