Provider Demographics
NPI:1952342628
Name:DESHMUKH, MADHAV NARAYAN (MD)
Entity Type:Individual
Prefix:
First Name:MADHAV
Middle Name:NARAYAN
Last Name:DESHMUKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8630 FENTON STREET
Mailing Address - Street 2:1204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:240-839-5811
Mailing Address - Fax:301-495-0318
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:1200
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910
Practice Address - Country:US
Practice Address - Phone:240-839-5811
Practice Address - Fax:301-495-0318
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158246-1207R00000X, 207RG0100X
MDD83485207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD207253000Medicaid
MDAW58-0118OtherCALCFIRST
NY00834235Medicaid