Provider Demographics
NPI:1821100991
Name:DESAI, JITENDRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:JITENDRA
Middle Name:M
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:203 SEWICKLEY RIDGE COURT
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143
Mailing Address - Country:US
Mailing Address - Phone:412-741-6413
Mailing Address - Fax:412-366-5377
Practice Address - Street 1:4725 MCKNIGHT RD
Practice Address - Street 2:SUITE #107
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237
Practice Address - Country:US
Practice Address - Phone:412-367-4200
Practice Address - Fax:412-366-5377
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD033865L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C32903Medicare UPIN
PA179661Medicare ID - Type Unspecified