1063570299 NPI number — AMEE B DESAI MD

Table of content: AMEE B DESAI MD (NPI 1063570299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063570299 NPI number — AMEE B DESAI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESAI
Provider First Name:
AMEE
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063570299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 64916
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-4916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-481-6482
Provider Business Mailing Address Fax Number:
443-481-6515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 MEDICAL PARKWAY
Provider Second Line Business Practice Location Address:
ACUTE CARE PAVILLION
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-481-1000
Provider Business Practice Location Address Fax Number:
443-481-1687
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA08183700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: D0070970 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 607156012 . This is a "FEDERAL WORKMAN'S COMP (DEPT OF LABOR)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 97128101 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: V8260028 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 520096200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 607156012 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".




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