Provider Demographics
NPI:1992701189
Name:DESAI, BHARAT V (MD)
Entity type:Individual
Prefix:
First Name:BHARAT
Middle Name:V
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:177 FRANKLIN CORNER RD
Mailing Address - Street 2:STE 1B
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2548
Mailing Address - Country:US
Mailing Address - Phone:609-896-2050
Mailing Address - Fax:609-896-2050
Practice Address - Street 1:177 FRANKLIN CORNER RD
Practice Address - Street 2:STE 1B
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2548
Practice Address - Country:US
Practice Address - Phone:609-896-2050
Practice Address - Fax:609-896-2050
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA02830700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2100100Medicaid
NJC55322Medicare UPIN
NJ452411Medicare ID - Type Unspecified