Provider Demographics
NPI:1861696262
Name:DEOSKAR, DHANANJAY S (MD, FAAP)
Entity type:Individual
Prefix:
First Name:DHANANJAY
Middle Name:S
Last Name:DEOSKAR
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17514 GALLOWAY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1952
Mailing Address - Country:US
Mailing Address - Phone:216-466-2063
Mailing Address - Fax:
Practice Address - Street 1:7103 S PEEK RD UNIT E3
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3498
Practice Address - Country:US
Practice Address - Phone:618-549-0721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8461208000000X
ILP8461208000000X
ND108282080N0001X
IL0361482432080N0001X
OH57011356208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14805Medicaid
ND14805Medicaid