MEDICARE: DR. PRAGNESH A. DESAI D.O.

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	208800000X	Urology Physician	05-005929-L	PA
2	208800000X	Urology Physician	OS-005929-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01188701	OTHER	PA	CAPITAL BLUE CROSS
2	990219	OTHER	PA	KHP CENTRAL & SENIOR BLUE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952393217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRAGNESH A. DESAI D.O.

Provider Business Mailing Address
First Line	:	6081 HAMILTON BLVD.
Second Line	:	SUITE 101
City	:	ALLENTOWN
State	:	PA
Zip	:	18106-9801
Country	:	US
Telephone Number	:	610-366-2112
Fax Number	:	610-366-2114

Provider Business Practice Location Address
First Line	:	6081 HAMILTON BLVD.
Second Line	:	SUITE 101
City	:	ALLENTOWN
State	:	PA
Zip	:	18106-9801
Country	:	US
Telephone Number	:	610-366-2112
Fax Number	:	610-366-2114

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	04/16/2019

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