Provider Demographics
NPI:1841383718
Name:DESAI, PRAFUL (MD)
Entity Type:Individual
Prefix:
First Name:PRAFUL
Middle Name:
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:PO BOX 5376
Mailing Address - Street 2:AFFILIATES IN PSYCHIATRY
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-0376
Mailing Address - Country:US
Mailing Address - Phone:302-738-7040
Mailing Address - Fax:302-738-7042
Practice Address - Street 1:100 ROCKFORD DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2120
Practice Address - Country:US
Practice Address - Phone:302-738-7040
Practice Address - Fax:302-738-7042
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00027152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000157101Medicaid
DE0000157101Medicaid
DE123395Medicare PIN