Basic Information
| Provider Information | |||||||||
| NPI: | 1508832692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | DIPAN | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 UPPER CHESAPEAKE DR | ||||||||
| Address2: | STE 201 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210144339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436433800 | ||||||||
| FaxNumber: | 4436433856 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 UPPER CHESAPEAKE DR | ||||||||
| Address2: | STE 201 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210144339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436433800 | ||||||||
| FaxNumber: | 4436433856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 12/30/2014 | ||||||||
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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 | 207R00000X | OS013114 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | H69649 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 418154900 | 05 | MD | MEDICAID |