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General NPI Number Information
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NPI Number | 1235769456
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Entity Type | Organization
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Legal Business Name | MEDICAL ASSOCIATES OF TERRE HAUTE, LLC
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Dates
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Enumeration Date | 01/16/2020
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 4320 S 7TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47802-4301
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Country | US
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Telephone | 812-905-0912
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Fax | 812-905-0913
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Provider Business Mailing Address
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Address Line | 4320 S 7TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47802-4301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | AJAY DESHPANDE
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Credential | MD
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Telephone | 812-605-0543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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