Provider Demographics
NPI:1952393217
Name:DESAI, PRAGNESH A (DO)
Entity Type:Individual
Prefix:DR
First Name:PRAGNESH
Middle Name:A
Last Name:DESAI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6081 HAMILTON BLVD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9801
Mailing Address - Country:US
Mailing Address - Phone:610-366-2112
Mailing Address - Fax:610-366-2114
Practice Address - Street 1:6081 HAMILTON BLVD.
Practice Address - Street 2:SUITE 101
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9801
Practice Address - Country:US
Practice Address - Phone:610-366-2112
Practice Address - Fax:610-366-2114
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05-005929-L208800000X
PAOS-005929-L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01188701OtherCAPITAL BLUE CROSS
PA990219OtherKHP CENTRAL & SENIOR BLUE
PA0012376230002Medicaid
E74082Medicare UPIN
PADE655860Medicare ID - Type Unspecified