Provider Demographics
NPI:1801984604
Name:DESHPANDE, AVINASH S (MD)
Entity type:Individual
Prefix:DR
First Name:AVINASH
Middle Name:S
Last Name:DESHPANDE
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 1:253 N STATE ROUTE 2
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-2203
Mailing Address - Country:US
Mailing Address - Phone:304-455-1019
Mailing Address - Fax:304-455-0141
Practice Address - Street 1:253 N STATE ROUTE 2
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-2203
Practice Address - Country:US
Practice Address - Phone:304-455-1019
Practice Address - Fax:304-455-0141
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6700375000Medicaid
WVH06777Medicare UPIN