Healthcare Provider Details

I. General information

NPI: 1588636971
Provider Name (Legal Business Name): VARSHA J. DESAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WALNUT AVE SW
ROANOKE VA
24016-4719
US

IV. Provider business mailing address

16 WALNUT AVE SW
ROANOKE VA
24016-4719
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-6468
  • Fax: 540-345-3204
Mailing address:
  • Phone: 540-345-6468
  • Fax: 540-345-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101-031753
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: