MEDICARE: DR. SHIVRAJ JAGDISH DESAI 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	207RP1001X	Pulmonary Disease Physician	MD031575E	PA

General Provider Information

NPI Number	:	1447291539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIVRAJ JAGDISH DESAI MD

Provider Business Mailing Address
First Line	:	1501 MOUNT PLEASANT RD
Second Line	:
City	:	VILLANOVA
State	:	PA
Zip	:	19085-2112
Country	:	US
Telephone Number	:	610-520-1395
Fax Number	:	610-520-1801

Provider Business Practice Location Address
First Line	:	1726 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2300
Country	:	US
Telephone Number	:	215-463-5008
Fax Number	:	215-463-4223

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/09/2007

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