Individual
DITI DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 SPRUCE ST BSMT WEST, PHILADELPHIA, PA 19106-4022
(215) 829-3264
(215) 829-8044
Mailing address
700 SPRUCE ST BSMT WEST, PHILADELPHIA, PA 19106-4022
(215) 829-3264
(215) 829-8044
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA057943
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
472044
MEDICARE
PA
Enumeration date
11/12/2015
Last updated
09/30/2019
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