Provider Demographics
NPI:1649246059
Name:DESAI, NIRAJ SURESH (MD)
Entity type:Individual
Prefix:DR
First Name:NIRAJ
Middle Name:SURESH
Last Name:DESAI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8724 BARRELLI CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8724 BARRELLI CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0269
Practice Address - Country:US
Practice Address - Phone:808-634-0829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4061207RN0300X
ME207RN0300X207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0030666OtherUNIVERSITY HLTH ALLIANCE
HIMD10952OtherCIGNA
HI00B0219267OtherHMSA
HI49496403OtherALOHA CARE
HI49496403Medicaid
HIMD10952OtherAETNA
HIF29068OtherKAISER
HIMD10952OtherMDX
HIH101100Medicare ID - Type Unspecified