Provider Demographics
NPI:1942281019
Name:DESAI, JITENDRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:JITENDRA
Middle Name:S
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:16 WALNUT AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4719
Mailing Address - Country:US
Mailing Address - Phone:540-345-6468
Mailing Address - Fax:540-345-3204
Practice Address - Street 1:16 WALNUT AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4719
Practice Address - Country:US
Practice Address - Phone:540-345-6468
Practice Address - Fax:540-345-3204
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010317522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00X250W01Medicare PIN