MEDICARE: DR. SATISH KESHAVRAO DESHPANDE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	186263	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255399960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SATISH KESHAVRAO DESHPANDE MD

Provider Business Mailing Address
First Line	:	28 NELSON ROAD
Second Line	:
City	:	SCARSDALE
State	:	NY
Zip	:	10583-5716
Country	:	US
Telephone Number	:	718-264-6705
Fax Number	:	718-264-6736

Provider Business Practice Location Address
First Line	:	21814 HEMPSTEAD AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-1235
Country	:	US
Telephone Number	:	718-360-8856
Fax Number	:	718-732-1472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	03/03/2011

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