1407274541 NPI number — MONAL DESAI M.D. (IN MAY 2014)

Table of content: MONAL DESAI M.D. (IN MAY 2014) (NPI 1407274541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407274541 NPI number — MONAL DESAI M.D. (IN MAY 2014)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESAI
Provider First Name:
MONAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D. (IN MAY 2014)
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:
1407274541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 ARCH ST
Provider Second Line Business Mailing Address:
STE 1B,
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44304-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-375-3315
Provider Business Mailing Address Fax Number:
330-375-7779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 ARCH ST
Provider Second Line Business Practice Location Address:
STE 1B,
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44304-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-375-3315
Provider Business Practice Location Address Fax Number:
330-375-7779
Provider Enumeration Date:
04/05/2014

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: A154456 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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