Provider Demographics
NPI:1891735924
Name:DESAI, USHA B (MD)
Entity Type:Individual
Prefix:DR
First Name:USHA
Middle Name:B
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-2207
Mailing Address - Country:US
Mailing Address - Phone:215-423-4005
Mailing Address - Fax:215-423-4005
Practice Address - Street 1:120 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2207
Practice Address - Country:US
Practice Address - Phone:215-423-4005
Practice Address - Fax:215-423-4005
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038063-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0898897Medicaid
PAC30367Medicare UPIN
PA000109099Medicare PIN