MEDICARE: DR. UJWALA VIVEK DESAI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D48105	MD

General Provider Information

NPI Number	:	1952307258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. UJWALA VIVEK DESAI MD

Provider Business Mailing Address
First Line	:	9501 OLD ANNAPOLIS ROAD
Second Line	:	SUITE 308
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042
Country	:	US
Telephone Number	:	301-621-6570
Fax Number	:	301-621-6589

Provider Business Practice Location Address
First Line	:	9501 OLD ANNAPOLIS ROAD
Second Line	:	SUITE 308
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042
Country	:	US
Telephone Number	:	301-621-6570
Fax Number	:	301-621-6589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	11/29/2016

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