Provider Demographics
NPI:1174614218
Name:DESAI, UMA SUBRAMANIAM (MD)
Entity type:Individual
Prefix:DR
First Name:UMA
Middle Name:SUBRAMANIAM
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:UMA
Other - Middle Name:S
Other - Last Name:IYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:907 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4036
Practice Address - Country:US
Practice Address - Phone:925-837-1044
Practice Address - Fax:925-837-1055
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532373OtherBLUE CROSS BLUE SHIELD
CA1174614218Medicaid
IL036107743Medicaid
CA1174614218Medicaid
IL213921002Medicare PIN
IL04532373OtherBLUE CROSS BLUE SHIELD
IL036107743Medicaid
IL214237Medicare PIN