Healthcare Provider Details

I. General information

NPI: 1043205230
Provider Name (Legal Business Name): DONALD JAMES DESIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST SUITE 150 S
WORCESTER MA
01608
US

IV. Provider business mailing address

100 FRONT ST 12TH FL
WORCESTER MA
01608
US

V. Phone/Fax

Practice location:
  • Phone: 508-368-3110
  • Fax: 508-368-3113
Mailing address:
  • Phone: 508-368-5510
  • Fax: 508-368-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number217435
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number232914
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: