Basic Information
Provider Information
NPI: 1003806977
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DESHPANDE
FirstName: SMITA
MiddleName: V
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 783311
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191783311
CountryCode: US
TelephoneNumber: 4848844500
FaxNumber: 4848840699
Practice Location
Address1: 1627 CHEW ST
Address2: GROUND FLOOR
City: ALLENTOWN
State: PA
PostalCode: 181023648
CountryCode: US
TelephoneNumber: 6109693390
FaxNumber: 6109693393
Other Information
ProviderEnumerationDate: 10/24/2005
LastUpdateDate: 04/10/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD039267LPAN Allopathic & Osteopathic PhysiciansFamily Medicine 
207QG0300XMD039267LPAY Allopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine

ID Information
IDTypeStateIssuerDescription
001463070000405PA MEDICAID
005086500001 IBCOTHER
46456901 HIGHMARK BLUE SHIELDOTHER
P00282001 GATEWAYOTHER
0316120101 CBCOTHER


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