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General NPI Number Information
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NPI Number | 1447291539
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Entity Type | Individual
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Provider Name | SHIVRAJ JAGDISH DESAI MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1726 S BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145-2300
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Country | US
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Telephone | 215-463-5008
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Fax | 215-463-4223
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Provider Business Mailing Address
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Address Line | 1501 MOUNT PLEASANT RD
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City | VILLANOVA
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State | PA
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Zip | 19085-2112
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Country | US
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Telephone | 610-520-1395
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Fax | 610-520-1801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD031575E
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License Number State | PA
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