Provider Demographics
NPI:1629353701
Name:DESAI, ATHENA KAMLESH (MAOM)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:KAMLESH
Last Name:DESAI
Suffix:
Gender:F
Credentials:MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 PEARL ST
Mailing Address - Street 2:#2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4761
Mailing Address - Country:US
Mailing Address - Phone:617-960-6472
Mailing Address - Fax:
Practice Address - Street 1:327 PEARL ST
Practice Address - Street 2:#2
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4761
Practice Address - Country:US
Practice Address - Phone:617-960-6472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist