Provider Demographics
NPI:1124122148
Name:DESAI, UDAY KUMAR (MD)
Entity type:Individual
Prefix:
First Name:UDAY
Middle Name:KUMAR
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 1:1275 SUMMER ST
Mailing Address - Street 2:SUITE # 102, STAMFORD VA PRIMARY CARE CENTER
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5359
Mailing Address - Country:US
Mailing Address - Phone:203-325-0764
Mailing Address - Fax:
Practice Address - Street 1:1275 SUMMER ST
Practice Address - Street 2:SUITE # 102, STAMFORD VA PRIMARY CARE CENTER
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5359
Practice Address - Country:US
Practice Address - Phone:203-325-0764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine