Healthcare Provider Details

I. General information

NPI: 1336866474
Provider Name (Legal Business Name): RAVI DESAI MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 CATHEDRAL CT
DAYTON OH
45458-4164
US

IV. Provider business mailing address

406 CATHEDRAL CT
DAYTON OH
45458-4194
US

V. Phone/Fax

Practice location:
  • Phone: 732-491-7164
  • Fax: 937-350-6477
Mailing address:
  • Phone: 732-491-7164
  • Fax: 937-350-6477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RAVI Y DESAI
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 732-491-7164