Healthcare Provider Details

I. General information

NPI: 1932385028
Provider Name (Legal Business Name): BALAJI DESAI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 11/29/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 EXECUTIVE DR STE K
DANVILLE VA
24541-4160
US

IV. Provider business mailing address

8320 PEARSON FARM CT
BROWNS SUMMIT NC
27214-9834
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-2751
  • Fax:
Mailing address:
  • Phone: 412-344-5619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD187963
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101239951
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101249951
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: