Provider Demographics
NPI:1982665758
Name:DANESH, SADEGH (MD)
Entity Type:Individual
Prefix:DR
First Name:SADEGH
Middle Name:
Last Name:DANESH
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 1:115 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020
Mailing Address - Country:US
Mailing Address - Phone:585-343-1502
Mailing Address - Fax:585-343-7202
Practice Address - Street 1:115 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020
Practice Address - Country:US
Practice Address - Phone:585-343-1502
Practice Address - Fax:585-343-7202
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1054641208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1809876OtherINDEPENDENT HEALTH
MD424KOtherPREFERRED CARE
NY00599660Medicaid
00010310101OtherUNIVERA
C58055Medicare UPIN
1809876OtherINDEPENDENT HEALTH