Healthcare Provider Details

I. General information

NPI: 1821100991
Provider Name (Legal Business Name): JITENDRA M DESAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 MCKNIGHT RD SUITE #107
PITTSBURGH PA
15237
US

IV. Provider business mailing address

203 SEWICKLEY RIDGE COURT
SEWICKLEY PA
15143
US

V. Phone/Fax

Practice location:
  • Phone: 412-367-4200
  • Fax: 412-366-5377
Mailing address:
  • Phone: 412-741-6413
  • Fax: 412-366-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD033865L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: