Provider Demographics
NPI:1780687715
Name:DESAI, NARENDRA G (MD)
Entity Type:Individual
Prefix:
First Name:NARENDRA
Middle Name:G
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 1:10721 MAIN ST STE 2450
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6911
Mailing Address - Country:US
Mailing Address - Phone:571-723-3366
Mailing Address - Fax:703-890-3092
Practice Address - Street 1:10721 MAIN ST STE 2450
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6911
Practice Address - Country:US
Practice Address - Phone:571-723-3366
Practice Address - Fax:703-890-3092
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025154207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA088861OtherANTHEM
VAMAMSIOther246818
VA2156OtherGROUP ID FOR B/C B/S
VA4087616OtherAETNA
VA088861OtherANTHEM
VAMAMSIOther246818