Provider Demographics
NPI:1649246059
Name:DESAI, NIRAJ SURESH (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRAJ
Middle Name:SURESH
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8724 BARRELLI CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0269
Mailing Address - Country:US
Mailing Address - Phone:808-634-0829
Mailing Address - Fax:
Practice Address - Street 1:116 NORTHPORT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6095
Practice Address - Country:US
Practice Address - Phone:207-338-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10952174400000X
ME207RN0300X207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0030666OtherUNIVERSITY HLTH ALLIANCE
HIF29068OtherKAISER
HI49496403OtherALOHA CARE
HI49496403Medicaid
HIMD10952OtherCIGNA
HIMD10952OtherMDX
HI00B0219267OtherHMSA
HIMD10952OtherAETNA
HIH101100Medicare ID - Type Unspecified