Healthcare Provider Details

I. General information

NPI: 1013414861
Provider Name (Legal Business Name): SAI PRASAD DESIKAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 E MONUMENT ST STE 416
BALTIMORE MD
21287-0020
US

IV. Provider business mailing address

1610 MOUNTAIN RIDGE RD
BATESVILLE AR
72501-8545
US

V. Phone/Fax

Practice location:
  • Phone: 443-927-3140
  • Fax: 410-367-2258
Mailing address:
  • Phone: 501-773-6408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0106590
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: