Provider Demographics
NPI:1053332627
Name:DESAI, JAYESH B (MD)
Entity type:Individual
Prefix:DR
First Name:JAYESH
Middle Name:B
Last Name:DESAI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:126 E CHURCH ST
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2271
Mailing Address - Country:US
Mailing Address - Phone:814-443-1908
Mailing Address - Fax:814-443-9908
Practice Address - Street 1:126 E CHURCH ST
Practice Address - Street 2:SUITE 3200
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2271
Practice Address - Country:US
Practice Address - Phone:814-443-1908
Practice Address - Fax:814-443-9908
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-03-05
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Provider Licenses
StateLicense IDTaxonomies
PAMD039011E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001202673Medicaid
710929Medicare PIN
608106Medicare ID - Type Unspecified
PA001202673Medicaid