MEDICARE: DR. ASHWIN V. DESHMUKH 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	51836	SC
2	207XX0801X	Orthopaedic Trauma Physician	51836	SC
3	207X00000X	Orthopaedic Surgery Physician	19799	PR

General Provider Information

NPI Number	:	1033258736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHWIN V. DESHMUKH MD

Provider Business Mailing Address
First Line	:	PO BOX 740
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00681-0740
Country	:	US
Telephone Number	:	310-274-1926
Fax Number	:

Provider Business Practice Location Address
First Line	:	349 AVE HOSTOS
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-1509
Country	:	US
Telephone Number	:	310-274-1926
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	03/17/2018

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