Provider Demographics
NPI:1144513235
Name:DESAI, PRIYAL (MBBS)
Entity type:Individual
Prefix:
First Name:PRIYAL
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 MAPLETON AVE STE 100A
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1561
Mailing Address - Country:US
Mailing Address - Phone:302-203-2440
Mailing Address - Fax:302-203-2461
Practice Address - Street 1:735 MAPLETON AVE STE 100A
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1561
Practice Address - Country:US
Practice Address - Phone:302-203-2440
Practice Address - Fax:302-203-2461
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0011852207R00000X, 207R00000X
MO2014029908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine