Provider Demographics
NPI:1700085834
Name:PRAMTHESH K DESAI MC FCCP
Entity Type:Organization
Organization Name:PRAMTHESH K DESAI MC FCCP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR PRAMTHESH DESAI
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMTHESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD FCCP
Authorized Official - Phone:570-270-4480
Mailing Address - Street 1:35 W LINDEN ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2635
Mailing Address - Country:US
Mailing Address - Phone:570-270-4480
Mailing Address - Fax:866-448-4667
Practice Address - Street 1:35 W LINDEN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2635
Practice Address - Country:US
Practice Address - Phone:570-270-4480
Practice Address - Fax:866-448-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067122L207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty