Provider Demographics
NPI:1679593909
Name:DESAI, BIJAL (MD)
Entity type:Individual
Prefix:DR
First Name:BIJAL
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
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:PO BOX 639856
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 W BUTLER RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2531
Practice Address - Country:US
Practice Address - Phone:864-297-1575
Practice Address - Fax:877-817-1801
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250322207R00000X
SCLL29227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC29227OtherSTATE LICENSE
VA0101250322Medicaid
SC292276Medicaid
VA0101250322OtherLISENCE
SC292276Medicaid
SC29227OtherSTATE LICENSE