Provider Demographics
NPI:1992770259
Name:DESAI, HARESH I (MD)
Entity type:Individual
Prefix:
First Name:HARESH
Middle Name:I
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 1:1008 S 5TH AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8676
Mailing Address - Country:US
Mailing Address - Phone:814-226-1599
Mailing Address - Fax:814-226-1583
Practice Address - Street 1:1008 S 5TH AVE
Practice Address - Street 2:STE 201
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8676
Practice Address - Country:US
Practice Address - Phone:814-226-1599
Practice Address - Fax:814-226-1583
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056503L207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015572840007Medicaid
1507400OtherGATEWAY
PA85840OtherUNISON MED PLUS
212525OtherUPMC
PA987273OtherHIGHMARK
PA0015572840007Medicaid
PA85840OtherUNISON MED PLUS