Provider Demographics
NPI:1912183179
Name:DESAI, TEJAS PRADEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:TEJAS
Middle Name:PRADEEP
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:P.O. BOX 751069
Mailing Address - Street 2:ECU PHYSICIANS: MANAGED CARE DEPARTMENT
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3258
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:2355 W ARLINGTON BLVD
Practice Address - Street 2:ECU PHYSICIANS NEPHROLOGY
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2847
Practice Address - Country:US
Practice Address - Phone:252-744-2545
Practice Address - Fax:252-744-4887
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01070207RN0300X
NY235462207R00000X
GA059062207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC154PNOtherBCBSNC
NCP00789108OtherRAILROAD MEDICARE
NC5913627Medicaid
NC2075172Medicare PIN