MEDICARE: DR. KALPANA S. 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	2085R0202X	Diagnostic Radiology Physician	25MA04036100	NJ
2	2085R0202X	Diagnostic Radiology Physician	ME125789	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	300122630	OTHER		RAILROAD MEDICARE
14	KP347	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10654859	OTHER		CAQH
3	2100749	OTHER		UNITED HEALTHCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	63402	OTHER		PREMIER BLUE
7	1144632	OTHER		HORIZON NJ HEALTH
8	2608168	OTHER		AETNA
9	0057263000	OTHER		AMERIHEALTH HMO
10	063402	OTHER		AMERIHEALTH PPO
11	63402	OTHER		HIGHMARK PA BLUE SHIELD
12	MRZ7W	OTHER	FL	BCBS OF FLORIDA
13	A3738029	OTHER		OXFORD HEALTH
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780682575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KALPANA S. DESHMUKH MD

Provider Business Mailing Address
First Line	:	PO BOX 1710
Second Line	:	SOUTH JERSEY RADIOLOGY ASSOCIATES, PA
City	:	VOORHEES
State	:	NJ
Zip	:	08043-7710
Country	:	US
Telephone Number	:	856-770-0504
Fax Number	:	856-770-0395

Provider Business Practice Location Address
First Line	:	2776 CLEVELAND AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-5864
Country	:	US
Telephone Number	:	239-343-2000
Fax Number	:	856-751-0535

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	06/06/2019

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