Provider Demographics
NPI:1386715258
Name:DESAI, HAREN PRAGJI (MD)
Entity type:Individual
Prefix:DR
First Name:HAREN
Middle Name:PRAGJI
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CURRIE CIR
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1201
Mailing Address - Country:US
Mailing Address - Phone:781-334-6731
Mailing Address - Fax:617-846-9346
Practice Address - Street 1:249 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1347
Practice Address - Country:US
Practice Address - Phone:617-846-7733
Practice Address - Fax:617-846-9346
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37970207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD82735Medicare UPIN
HA M13117Medicare ID - Type Unspecified