Individual
MR. GAUTAM D DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2020 S INDEPENDENCE BLVD, SUITE #3, VIRGINIA BEACH, VA 23453
(757) 471-6977
(757) 471-5300
Mailing address
2020 S INDEPENDENCE BLVD, SUITE #3, VIRGINIA BEACH, VA 23453
(757) 471-6977
(757) 471-5300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101045379
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005628881
—
VA
01
—
080100260
RR MEDICARE
—
01
—
332419
BLUE CROSS/BLUE SHIELD
—
Enumeration date
10/16/2006
Last updated
06/24/2010
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