MEDICARE: SMITA V DESHPANDE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME158311	FL
2	207Q00000X	Family Medicine Physician	MD039267L	PA
3	207QG0300X	Geriatric Medicine (Family Medicine) Physician	MD039267L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0050865000	OTHER	IBC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P002820	OTHER	GATEWAY
4	464569	OTHER	HIGHMARK BLUE SHIELD
5	03161201	OTHER	CBC

General Provider Information

NPI Number	:	1003806977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SMITA V DESHPANDE MD

Provider Business Mailing Address
First Line	:	777 GLADES RD # SS 8W240
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-6496
Country	:	US
Telephone Number	:	561-297-3512
Fax Number	:	561-297-0494

Provider Business Practice Location Address
First Line	:	777 GLADES RD # SS 8W240
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-6424
Country	:	US
Telephone Number	:	610-969-3390
Fax Number	:	610-969-3393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	11/08/2023

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Directions to “ SMITA V DESHPANDE MD” Practice Location

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