Provider Demographics
NPI:1417575473
Name:DESAI, HEMAL KISHORBHAI (PA-C)
Entity type:Individual
Prefix:
First Name:HEMAL
Middle Name:KISHORBHAI
Last Name:DESAI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 GREAT GLN
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-7486
Mailing Address - Country:US
Mailing Address - Phone:219-669-8442
Mailing Address - Fax:
Practice Address - Street 1:1 CIRRUS DR APT 105
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-4431
Practice Address - Country:US
Practice Address - Phone:219-669-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC0010-10280363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program