Basic Information
| Provider Information | |||||||||
| NPI: | 1316148794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | PRIYANK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7200 | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278040200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529370200 | ||||||||
| FaxNumber: | 2524510056 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 N WINSTEAD AVE | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278048467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529370235 | ||||||||
| FaxNumber: | 2529373102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 03/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 2013-01160 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 390200000X | P19906 | MD | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | MD.31091 | AL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RP1001X | 2013-01160 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | P01251557 | 01 | NC | RAILROAD MEDICARE | OTHER | 2246717 | 01 | NC | BCBS OF NC | OTHER | 1316148794 | 05 | NC | MEDICAID | 3643901 | 01 | NC | MEDCOST | OTHER | 247302 | 01 | NC | CIGNA | OTHER | 181YH | 01 | NC | AETNA | OTHER |