Provider Demographics
NPI:1780021170
Name:DESAI, AJINKYA SHRINIVAS (MBBS)
Entity Type:Individual
Prefix:DR
First Name:AJINKYA
Middle Name:SHRINIVAS
Last Name:DESAI
Suffix:
Gender:M
Credentials:MBBS
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Other - Credentials:
Mailing Address - Street 1:2500 N. STATE STREET
Mailing Address - Street 2:CBO-SUITE 4200
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-496-9794
Mailing Address - Fax:601-815-0434
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-2005
Practice Address - Fax:601-815-0434
Is Sole Proprietor?:No
Enumeration Date:2013-05-27
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS270002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology