Provider Demographics
NPI:1306883608
Name:DESAI, PRAFUL V (MD)
Entity type:Individual
Prefix:DR
First Name:PRAFUL
Middle Name:V
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 BRADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1458
Mailing Address - Country:US
Mailing Address - Phone:724-547-4547
Mailing Address - Fax:724-547-7460
Practice Address - Street 1:1 BRADDOCK AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1458
Practice Address - Country:US
Practice Address - Phone:724-547-4547
Practice Address - Fax:724-547-7460
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD021125E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006399500001Medicaid
PA1306883608OtherRAILROAD MEDICARE
PA0006399500001Medicaid
PAE55775Medicare UPIN