Healthcare Provider Details

I. General information

NPI: 1942463542
Provider Name (Legal Business Name): RICHARD DESI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ST PAUL PLACE # 718
BALTIMORE MD
21202
US

IV. Provider business mailing address

301 ST PAUL PLACE MEDICAL STAFF OFFICE
BALTIMORE MD
21202
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9356
  • Fax:
Mailing address:
  • Phone: 410-951-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0067726
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: